Effect of an optimized treatment with insulin on platelet reactivity after discharge in patients with an acute coronary syndrome and hyperglycemia.
OBJECTIVE
Intensive glucose control with insulin in patients with an acute coronary syndrome reduces platelet reactivity during hospitalization, compared to conventional control. However, the effect of strict, long-term glucose control on platelet reactivity in these patients remains uncertain.


METHODS
This is a prospective, randomized trial evaluating the effects of optimized glucose control (target glucose, 80-120mg/dL) with insulin, compared with conventional control (target glucose, <180 mg/dL), on platelet reactivity after hospital discharge in patients with an acute coronary syndrome and hyperglycemia. The primary endpoint was assessment of platelet aggregation after stimulation with adenosine diphosphate 20 μM at 12-month follow-up.


RESULTS
One hundred four patients were randomized to optimized management (n=53) or conventional management (n=51). There were no differences between groups in baseline characteristics or platelet function. After 12 months of follow-up, blood glucose levels were significantly lower in the optimized treatment group (104 vs 119 mg/dL; P<.001). However, platelet aggregation following adenosine diphosphate 20 μM stimulation showed no differences between the groups (54.2% [14.3%] vs 55.1% [18.3%] respectively; P=.81). There were no significant differences for other platelet function tests.


CONCLUSIONS
Long-term optimized glucose control with insulin in patients with an acute coronary syndrome did not result in a reduction in platelet reactivity compared to conventional control.
Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain. Electronic address: dvivas@secardiologia.es.
David
D
Vivas
Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
Juan C
JC
García-Rubira
Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
Esther
E
Bernardo
Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
Dominick J
DJ
Angiolillo
Servicio de Endocrinología, Hospital Clínico San Carlos, Madrid, Spain.
Patricia
P
Martín
Servicio de Endocrinología, Hospital Clínico San Carlos, Madrid, Spain.
Alfonso
A
Calle
Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
Iván
I
Núñez-Gil
Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
Carlos
C
Macaya
Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
Antonio
A
Fernández-Ortiz
D054058:Acute Coronary Syndrome / Q000097:blood* / Q000150:complications / Q000188:drug therapy*; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D001792:Blood Platelets / Q000187:drug effects*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000150:complications / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010979:Platelet Function Tests; D011446:Prospective Studies
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
ACS; ADP; Acute coronary syndrome; Diabetes mellitus; Plaquetas; Platelets; Síndrome coronario agudo; acute coronary syndrome; adenosine diphosphate