Journal of Thrombosis and Thrombolysis

, Volume 35, Issue 2, pp 165–174 | Cite as

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”)
  • David Vivas
  • Juan C. García-Rubira
  • Esther Bernardo
  • Dominick J. Angiolillo
  • Patricia Martín
  • Alfonso Calle-Pascual
  • Iván Núñez-Gil
  • Carlos Macaya
  • Antonio Fernández-Ortiz
Article
First Online:

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.

Keywords

Platelets HbA1c Acute coronary syndrome 

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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Notes

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.

Supplementary material

11239_2012_834_MOESM1_ESM.doc (58 kb)
Supplementary material 1 (DOC 58 kb)
11239_2012_834_MOESM2_ESM.doc (54 kb)
Supplementary material 2 (DOC 54 kb)

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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • David Vivas
    • 1
  • Juan C. García-Rubira
    • 1
  • Esther Bernardo
    • 1
  • Dominick J. Angiolillo
    • 1
  • Patricia Martín
    • 1
  • Alfonso Calle-Pascual
    • 1
  • Iván Núñez-Gil
    • 1
  • Carlos Macaya
    • 1
  • Antonio Fernández-Ortiz
    • 1
  1. 1.Cardiovascular InstituteSan Carlos University HospitalMadridSpain

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