Platelet Dependent Thrombogenicity, Inflammation and Five Year Mortality in Patients with Non-ST Elevation Acute Coronary Syndrome and Type 2 Diabetes Mellitus: An Observational Study

Platelet dependent thrombogenicity is higher in type 2 diabetes mellitus (T2DM) but there is no data on association between thrombus and mortality or vascular inflammation. We studied 80 patients who received guideline based therapy (40 T2DM) after NSTE-ACS. Platelet dependent thrombus was assessed using the validated ex vivo Badimon Chamber and all patients were followed up for five years. Bio-markers of coagulation and inflammation were measured. There were 17 (21.3%) deaths in total (12 in the T2DM, 71% of all deaths), at 5 years. Of the patients who died, thrombus burden was higher ({micro}2 per mm, Mean {+/-} SD, 12,164 {+/-} 3235 vs 9,751 {+/-} 4333). Serum inflammatory cytokines, P selectin and soluble CD40 ligand were higher in T2DM. Univariate analysis showed thrombus area, diabetic status, age, interleukin 1 and P selectin were independent predictors of mortality. Inflammatory biomarkers were associated with thrombus burden. If these findings can be proven in large scale studies, this will lead on to novel therapeutic strategies especially in the current Covid 19 pandemic which has renewed our interest of this interplay of pathophysiology between thrombus and inflammation.