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'')
Loading...
Official URL
Full text at PDC
Publication date
2011
Authors
García-Rubira, Juan Carlos
Bernardo, Esther
Angiolillo, Dominick J
Martín, Patricia
Núñez Gil, Iván
Advisors (or tutors)
Editors
Journal Title
Journal ISSN
Volume Title
Publisher
BMJ Publishing Group
Citations
Exportar
Citation
Vivas D, García-Rubira JC, Bernardo E, Angiolillo DJ, Martín P, Calle-Pascual A, et al. 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 Sindrome Coronario Agudo"). Heart. 2011;97:803-9
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.
Description
Ensayo clínico aleatorizado no ciego donde 115 pacientes con hiperglucemia que ingresan con un síndrome coronario agudo se aleatorizaron a un control invasivo de la glucemia versus un control convencional. El estudio objetivó como el tratamiento intensivo de la hiperglucemia redujo significativamente la reactividad plaquetaria en comparación con el tratamiento convencional.