Key result
Early intensive insulin reduces maximal platelet aggregation by ~19% at discharge in hyperglycemic ACS.
Why the study?
Hyperglycaemia is associated with increased platelet reactivity and impaired prognosis in ACS, but whether lowering glucose reduces platelet reactivity is unknown.
Does intensive glucose control with insulin reduce platelet reactivity in patients with acute coronary syndrome and hyperglycaemia?
RCT (n=115)
Open-label
1:1
No
Does intensive glucose control with insulin reduce platelet reactivity in patients with acute coronary syndrome and hyperglycaemia?
Early intensive glucose control with insulin in patients with ACS and hyperglycemia significantly decreases platelet reactivity at hospital discharge.
Intensive insulin may modulate thrombotic risk via platelet effects in hyperglycemic ACS; extends randomized mechanistic data on glucose control.
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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Vivas et al. (2011) conducted an RCT in Acute coronary syndrome with hyperglycemia (n=115). Intensive glucose control with insulin vs. Conventional glucose control (target glucose ≤180 mg/dl) was evaluated on Maximal platelet aggregation following stimuli with 20 mM ADP at hospital discharge (p=0.002). Early intensive glucose control with insulin in patients with acute coronary syndrome and hyperglycemia significantly reduced maximal platelet aggregation at hospital discharge (47.9% vs 59.1%, p=0.002).
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