title: Effect of glycemic control on response to antiplatelet therapy in patients with diabetes mellitus and ST-segment elevation myocardial infarction.
abstract: Impaired glycemic control (GC) is a troubling clinical condition with an unclear prognostic value that is frequent in diabetics, especially in the setting of acute coronary syndrome. Residual platelet reactivity can be also affected by GC. We evaluated the relation between response to dual antiplatelet therapy and GC in diabetics with STEMI treated with primary coronary angioplasty (PCI). Sixty diabetic patients were prospectively enrolled in the study. All patients were treated with clopidogrel and aspirin. Platelet reactivity (whole blood aggregation and phosphorylation of vasodilator-stimulated phosphoprotein, VASP) were assessed serially before and 24 hours, 7 days, and 30 days after the PCI. Blood glucose >8.5 mmol/L on admission was an independent predictor of a impaired clopidogrel response measured with platelet reactivity index (PRI) >50% on admission (OR 7.8, 95% CI 1.4-17.7, p<0.02) and 24 hours after PCI (OR 13.1, 95% CI 3.4-28.1, p<0.01). In conclusion, diabetic patients with STEMI and glycemia >8.5 mmol/L on admission is related to a poorer response to clopidogrel. There were no interaction between glycated hemoglobin level or glycemia on admission and platelet reactivity measured with collagen, arachidonic acid or thrombin receptor agonist peptide-induced aggregation. Further clinical studies of the role of GC in the efficacy of antiplatelet agents are warranted.
authors.affiliation: 3rd Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland. wkuliczkowski@wp.pl
authors.forename: Wiktor
authors.initials: W
authors.lastname: Kuliczkowski
authors.forename: Mariusz
authors.initials: M
authors.lastname: Gąsior
authors.forename: Damian
authors.initials: D
authors.lastname: Pres
authors.forename: Jacek
authors.initials: J
authors.lastname: Kaczmarski
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Greif
authors.forename: Anna
authors.initials: A
authors.lastname: Łaszewska
authors.forename: Marta
authors.initials: M
authors.lastname: Szewczyk
authors.forename: Michal
authors.initials: M
authors.lastname: Hawranek
authors.forename: Mateusz
authors.initials: M
authors.lastname: Tajstra
authors.forename: Sławomir
authors.initials: S
authors.lastname: Żegleń
authors.forename: Lech
authors.initials: L
authors.lastname: Poloński
authors.forename: Victor
authors.initials: V
authors.lastname: Serebruany
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D001241:Aspirin / Q000627:therapeutic use*; D001786:Blood Glucose / Q000032:analysis*; D000077144:Clopidogrel; D058065:Diabetic Cardiomyopathies / Q000097:blood*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000503:physiopathology / Q000628:therapy; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011446:Prospective Studies; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D001786:Blood Glucose; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin