Influence Of Hemoglobin A1c Levels On The Residual Platelet Reactivity And Outcomes After Coronary Placement Of Drug-eluting Stent

First part: Influence of Hemoglobin A1c levels on platelet reactivity: a clinical studyPurpose: To explore the relationships between Hemoglobin A1c levels and platelet reactivity with the aim of guiding anti-platelet therapy in patients with hyperglycemia after coronary drug-eluting stent placement.Methods and materials: From January 2014 to October 2015,582 patients admitted in Shanghai Chest Hospital underwent percutaneous coronary intervention with drug-eluting stent and platelet reactivity test with Thromboelastographic and HbA1c test were retrospectively reviewed.HbA1c levels measured for all patients were stratified by HbA1c<6.5%,6.5%? HbA1c? 8.5%,and >8.5% for three groups.Resistance on clopidogrel(ROC)and Aspirin(ROA)after loading dose of clopidogrel and aspirin were defined as the inhibition rate of platelet lower than 30%,and 50%,respectively.The inhibition ratios of ADP and AA among three groups were compared and analyzed statistically.Univariate and multivariate binary logistic regression were performed on the basis of ROC and ROA set as dependent variate and HbA1c levels set as independent variate.Results :The patients in group with HbA1c >8.5% were more likely male,had a higher levels of brain natriuretic peptide(BNP)and higher proportion of left main lesions and calcified lesions.Resistance on clopidogrel(ROC)was rare(5%,29/582),proportions of ROC among three HbA1c groups had no statistical significance(4.3% vs 6.1% vs.7.1%,P=0.62),Whereas Resistance on Aspirin(ROA)was frequent 16.5%(96/582),proportions of ROA among HbA1c groups had no statistical significance either(16.4% vs 17.7% vs 14.3%,P=0.77).The inhibition ratio of ADP and AA among three groups(HbA1c<6.5;6.5?HbA1c?8.5;HbA1c >8.5)were [M(Q1,Q3),(90.8(57.6,98.6),80(52.4,98.2),75(43.4,97.1),p=0.09],and [M(Q1,Q3),88.8(60.2,98.6),88.1(61.2,97.9),83.9(61.1,98),P=0.83],respectively.In univariate and multivariate binary regression analysis,there was no association between HbA1c levels and the inhibition ratio of ADP or AA with P value both >0.05.Conclusion: In our study there was no association between HbA1C levels and the inhibition ratio of ADP and AA tested by TEG,and that HbA1C levels was not a dependent risk factor for high platelet reactivity after loading dose of dual anti-platelet treatment with aspirin and clopidogrel.Second part:Influence of Hemoglobin A1c levels on outcomes after coronary drug-eluting stent insertion: a clinical studyPurpose: To study the influence of Hemoglobin A1C levels on outcomes after coronary drug-eluting stent placement in order to guide management of glycemic control in patients with hyperglycemic after coronary drug-eluting insertion.Methods and materials: From January 2014 to October 2015,582 patients received percutaneous coronary intervention with drug-eluting stent and platelet reactivity test with Thromboelastographic and HbA1c test were retrospectively reviewed and followed-up for one-year incidence of main adverse cardiovascular events and bleeding events.All patients received HbA1c test were stratified into three groups(HbA1c<6.5;6.5 ?HbA1c?8.5;HbA1c>8.5)based on HbA1c levels.Resistance on Clopidogrel was defined as the inhibition rate of ADP lower than 30%,Resistance on Aspirin was as the inhibition rate of AA lower than 50%.The incidence of MACE and bleeding events among three groups were compared by Kaplan Meier survival curve.Univariate and multivariate binary logistic regression were also performed among three groups on the basis of MACE and bleeding events set as dependent variates and HbA1c levels and ROC set as analyzing factors.Results: Out of 582 patients,541(92.8%)completed one-year follow-up.There were statistical significant difference(P value<0.05)in endpoints of target lesions revascularization and cardiac death not in stent thrombosis and new myocardial infarction by Kaplan Meier survival curve analysis.In adjusted model with binary logistic analysis,high levels of HbA1c(>8.5%)was an independent risk factor for target lesion revascularization(TLV)(OR=5.56,95%CI 2.14-14.40,P= 0.000),cardiac death(OR=7.90,95%CI 1.08-57.71,p=0.042),and MACE(OR=4.66,95%CI 2.01-10.80,p= 0.000)at one-year follow-up;ROC was an independent risk factor for TLR(OR=4.50,95%CI 1.51-13.36,p=0.007),and MACE(OR=3.72,95%CI 1.37-10.13,p= 0.01).There were no association between bleeding events and HbA1c levels or ROC.Conclusion: Poor glycemic control and ROC were drivers for the incidence of MACE after coronary drug-eluting stent placement,which was mainly enabled by TLR after Percutaneous coronary intervention,rationalizing an argument for intensified glycemic control and antiplatelet therapy for patients accepting coronary drug-eluting stent insertion.