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Effects of intensive glucose control on platelet reactivity in patients with acute coronary syndromes. Results of the CHIPS Study (“Control de Hiperglucemia y Actividad Plaquetaria en Pacientes con Síndrome Coronario Agudo”)
  1. David Vivas1,
  2. Juan C García-Rubira1,
  3. Esther Bernardo1,
  4. Dominick J Angiolillo1,
  5. Patricia Martín2,
  6. Alfonso Calle-Pascual2,
  7. Iván Núñez-Gil1,
  8. Carlos Macaya1,
  9. Antonio Fernández-Ortiz1
  1. 1Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain
  2. 2Department of Endocrinology, San Carlos University Hospital, Madrid, Spain
  1. Correspondence to Dr David Vivas, Cardiovascular Institute, San Carlos University Hospital, Profesor Martin Lagos s/n 28040, Madrid, Spain; dvivas{at}secardiologia.es

Abstract

Objectives Hyperglycaemia has been associated with increased platelet reactivity and impaired prognosis in patients with acute coronary syndrome (ACS). Whether platelet reactivity can be reduced by lowering glucose in this setting is unknown. The aim of this study was to assess the functional impact of intensive glucose control with insulin on platelet reactivity in patients admitted with ACS and hyperglycaemia.

Methods This is a prospective, randomised trial evaluating the effects of either intensive glucose control (target glucose 80–120 mg/dl) or conventional control (target glucose 180 mg/dl or less) with insulin on platelet reactivity in patients with ACS and hyperglycaemia. The primary endpoint was platelet aggregation following stimuli with 20 μM ADP at 24 h and at hospital discharge. 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 were also measured.

Results Of the 115 patients who underwent random assignment, 59 were assigned to intensive and 56 to conventional glucose control. Baseline platelet functions and inhospital management were similar in both groups. Maximal aggregation after ADP stimulation at hospital discharge was lower in the intensive group (47.9±13.2% vs 59.1±17.3%; p=0.002), whereas no differences were found at 24 h. Similarly all other parameters of platelet reactivity measured at hospital discharge were significantly reduced in the intensive glucose control group.

Conclusions In this randomised trial, early intensive glucose control with insulin in patients with ACS presenting with hyperglycaemia was found to decrease platelet reactivity.

Clinical Trial Registration Number http://www.controlledtrials.com/ISRCTN35708451/ISRCTN35708451.

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Footnotes

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

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study complied with the Declaration of Helsinki and was approved by the ethical committee of the San Carlos University Hospital, Madrid, Spain.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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