NEW YORK (Reuters Health) – Poor glycemic control in diabetics with ST-segment elevation myocardial infarction (STEMI) is associated with an impaired antiplatelet response to clopidogrel, a new study shows.

”I think that we should keep the glycemia at admission in acute coronary syndrome (ACS) patients with diabetes at levels below 8.5 mmol/L,” Dr. Wiktor Kuliczkowski from Silesian Center for Heart Diseases, Zabrze, Poland, told Reuters Health in an email. ”I think the 8.5 mmol/L (160 mg/dL) can be considered our goal, at least for platelet reactivity.”

In a prospective study of 60 diabetic patients with STEMI, Dr. Kuliczkowski and colleagues assessed platelet reactivity before percutaneous coronary intervention (PCI) and 24 hours, 7 days, and 30 days afterward. Everyone in the study received clopidogrel and aspirin, according to a report online April 30 in the American Journal of Cardiology.

Blood glucose levels above 8.5 mmol/L on admission independently predicted increased platelet reactivity on admission and 24 hours and 7 days after PCI, but not at 30 days.

There was a significant correlation between glycemic level and response to clopidogrel on admission and 24 hours after stenting.

Hemoglobin A1c on admission did not influence the response to clopidogrel treatment, and neither glycemic control nor HbA1c level on admission influenced the response to aspirin or to platelet aggregation induced by collagen or thrombin receptor agonist peptide.

”We did not show it but we think lowering the blood glucose level below 8.5 mmol/L and maintaining saline infusion can ameliorate the hyperosmolar state of blood and help clopidogrel to overcome the transient resistance,” Dr. Kuliczkowski said.

”We need (a) bigger study on this topic before making firm recommendations,” he admitted. ”Our study was a small one, for generating ideas only.”

Am J Cardiol 2012 June

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