Influence of HbA1c levels on platelet function profiles associated with tight glycemic control in patients presenting with hyperglycemia and an acute coronary syndrome: A subanalysis of the CHIPS Study (“Control deHIperglucemia y ActividadPlaquetaria en Pacientes conSíndrome Coronario Agudo”)

Patients with hyperglycemia, an acute coronary syndrome and poor glycemic control have increased platelet reactivity and poor prognosis. However, it is unclear the influence of a tight glycemic control on platelet reactivity in these patients. This is a subanalysis of the CHIPS study. This trial ran...

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Published in:Journal of thrombosis and thrombolysis 2013-02, Vol.35 (2), p.165-174
Main Authors: Vivas, David, García-Rubira, Juan C., Bernardo, Esther, Angiolillo, Dominick J., Martín, Patricia, Calle-Pascual, Alfonso, Núñez-Gil, Iván, Macaya, Carlos, Fernández-Ortiz, Antonio
Format: Article
Language:English
Subjects:
Acute Coronary Syndrome - blood
Acute Coronary Syndrome - diagnosis
Acute Coronary Syndrome - epidemiology
Aged
Aged, 80 and over
Biomarkers - blood
Blood Glucose - metabolism
Cardiology
Female
Glycated Hemoglobin A - biosynthesis
Glycated Hemoglobin A - physiology
Glycemic Index - physiology
Hematology
Humans
Hyperglycemia - blood
Hyperglycemia - diagnosis
Hyperglycemia - epidemiology
Male
Medicine
Medicine & Public Health
Middle Aged
Platelet Aggregation - physiology
Platelet Function Tests - methods
Prospective Studies
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container_title Journal of thrombosis and thrombolysis
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creator Vivas, David
García-Rubira, Juan C.
Bernardo, Esther
Angiolillo, Dominick J.
Martín, Patricia
Calle-Pascual, Alfonso
Núñez-Gil, Iván
Macaya, Carlos
Fernández-Ortiz, Antonio
description Patients with hyperglycemia, an acute coronary syndrome and poor glycemic control have increased platelet reactivity and poor prognosis. However, it is unclear the influence of a tight glycemic control on platelet reactivity in these patients. This is a subanalysis of the CHIPS study. This trial randomized patients with hyperglycemia to undergo an intensive glucose control (target blood glucose 80–120 mg/dL), or conventional glucose control (target blood glucose
doi_str_mv 10.1007/s11239-012-0834-3
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However, it is unclear the influence of a tight glycemic control on platelet reactivity in these patients. This is a subanalysis of the CHIPS study. This trial randomized patients with hyperglycemia to undergo an intensive glucose control (target blood glucose 80–120 mg/dL), or conventional glucose control (target blood glucose &lt;180 mg/dL). We analyzed platelet function at discharge on the subgroup of patients with poor glycemic control, defined with admission levels of HbA1c higher than 6.5 %. The primary endpoint was maximal platelet aggregation following stimuli with 20 μM ADP. We also measured aggregation following collagen, epinephrine, and thrombin receptor-activated peptide, as well as P2Y12 reactivity index and surface expression of glycoprotein IIb/IIIa and P-selectin. A total of 67 patients presented HbA1c ≥ 6.5 % (37 intensive, 30 conventional), while 42 had HbA1c &lt; 6.5 % (20 intensive, 22 conventional). There were no differences in baseline characteristics between groups. At discharge, patients with HbA1c ≥6.5 % had significantly reduced MPA with intensive glucose control compared with conventional control (46.1 ± 22.3 vs. 60.4 ± 20.0 %; p  = 0.004). Similar findings were shown with other measures of platelet function. However, glucose control strategy did not affect platelet function parameters in patients with HbA1c &lt; 6.5 %. 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However, it is unclear the influence of a tight glycemic control on platelet reactivity in these patients. This is a subanalysis of the CHIPS study. This trial randomized patients with hyperglycemia to undergo an intensive glucose control (target blood glucose 80–120 mg/dL), or conventional glucose control (target blood glucose &lt;180 mg/dL). We analyzed platelet function at discharge on the subgroup of patients with poor glycemic control, defined with admission levels of HbA1c higher than 6.5 %. The primary endpoint was maximal platelet aggregation following stimuli with 20 μM ADP. We also measured aggregation following collagen, epinephrine, and thrombin receptor-activated peptide, as well as P2Y12 reactivity index and surface expression of glycoprotein IIb/IIIa and P-selectin. A total of 67 patients presented HbA1c ≥ 6.5 % (37 intensive, 30 conventional), while 42 had HbA1c &lt; 6.5 % (20 intensive, 22 conventional). There were no differences in baseline characteristics between groups. At discharge, patients with HbA1c ≥6.5 % had significantly reduced MPA with intensive glucose control compared with conventional control (46.1 ± 22.3 vs. 60.4 ± 20.0 %; p  = 0.004). Similar findings were shown with other measures of platelet function. However, glucose control strategy did not affect platelet function parameters in patients with HbA1c &lt; 6.5 %. Intensive glucose control in patients presenting with an acute coronary syndrome and hyperglycemia results in a reduction of platelet reactivity only in the presence of elevated HbA1c levels.</abstract><cop>Boston</cop><pub>Springer US</pub><pmid>23114538</pmid><doi>10.1007/s11239-012-0834-3</doi><tpages>10</tpages></addata></record>
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subjects Acute Coronary Syndrome - blood
Acute Coronary Syndrome - diagnosis
Acute Coronary Syndrome - epidemiology
Aged
Aged, 80 and over
Biomarkers - blood
Blood Glucose - metabolism
Cardiology
Female
Glycated Hemoglobin A - biosynthesis
Glycated Hemoglobin A - physiology
Glycemic Index - physiology
Hematology
Humans
Hyperglycemia - blood
Hyperglycemia - diagnosis
Hyperglycemia - epidemiology
Male
Medicine
Medicine & Public Health
Middle Aged
Platelet Aggregation - physiology
Platelet Function Tests - methods
Prospective Studies
title Influence of HbA1c levels on platelet function profiles associated with tight glycemic control in patients presenting with hyperglycemia and an acute coronary syndrome: A subanalysis of the CHIPS Study (“Control deHIperglucemia y ActividadPlaquetaria en Pacientes conSíndrome Coronario Agudo”)
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