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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 (“C ontrol de HI perglucemia y Actividad P laquetaria en Pacientes con S índrome Coronario Agudo”)

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Abstract

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 <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 < 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 < 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.

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Abbreviations

ACS:

Acute coronary syndrome

ADP:

Adenosine diphosphate

DM:

Diabetes mellitus

HbA1c:

Glycated haemoglobin

LTA:

Light transmission aggregometry

TRAP:

Thrombin receptor-activated peptide

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Acknowledgments

This study was funded by a non-restricted grant from the Fundación Investigación y Desarrollo Area Cardiovascular FIC (Madrid, Spain CIF G-81563801).

Conflict of interest

There are no relationship to disclosure between authors and the industry related to the present work.

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Authors and Affiliations

  1. Cardiovascular Institute, San Carlos University Hospital, Profesor Martin Lagos s/n, 28040, Madrid, Spain

    David Vivas, Juan C. García-Rubira, Esther Bernardo, Dominick J. Angiolillo, Patricia Martín, Alfonso Calle-Pascual, Iván Núñez-Gil, Carlos Macaya & Antonio Fernández-Ortiz

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  1. David Vivas
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  2. Juan C. García-Rubira
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  3. Esther Bernardo
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  4. Dominick J. Angiolillo
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  6. Alfonso Calle-Pascual
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  7. Iván Núñez-Gil
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  9. Antonio Fernández-Ortiz
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Correspondence to David Vivas.

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Vivas, D., García-Rubira, J.C., Bernardo, E. et al. Influence of HbA1c levels on platelet function profiles associated with tight glycemic control in patients presenting with hyperglycemia and an acute coronary syndrome. J Thromb Thrombolysis 35, 165–174 (2013). https://doi.org/10.1007/s11239-012-0834-3

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