Department of Cardiology, Jiading Branch of Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, 800 Huangjiahuayuan Road, Shanghai, 201803, People's Republic of China.
Department of Emergency and Critical Care, Jiading Branch of Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, 800 Huangjiahuayuan Road, Shanghai, 201803, People's Republic of China.
Sci Rep. 2024 Nov 29;14(1):29699. doi: 10.1038/s41598-024-81537-1.
This study investigates the impact of hemoglobin A1c on platelet reactivity and cardiovascular outcomes in patients undergoing drug-eluting stent implantation. HbA1c levels were categorized into 3 groups: < 6.5%, 6.5-8.5%, and > 8.5%. ROC (resistance to clopidogrel) and ROA (resistance to aspirin) were calculated. The primary endpoint was a composite of MACE, including all-cause mortality, nonfatal MI, and ischemia-driven revascularization. The secondary endpoints comprised individual MACE components. The incidence of ROC was 9.3% (151 of 1621), whereas that of ROA was 16.5% (268 of 1621). The ROC for each of the 3 groups significantly increased with increasing HbA1c levels [4.3% vs. 7.1% vs. 10.1%, p = 0.006]; however, the ROA did not [16.4% vs. 17.7% vs. 14.3%, P = 0.694]. HbA1c > 8.5 was significantly associated with ROC (3.356 [1.231, 9.234], p = 0.009). Compared with the HbA1c < 6.5 subgroup, the HbA1c˃8.5 subgroup was significantly associated with MACE (3.142 [2.346, 4.206], < 0.001), nonfatal MI (2.297 [1.275, 4.137], P = 0.006) and ischemia-driven revascularization (3.845 [2.082, 7.101], p < 0.001), but not all-cause mortality (2.371 [0.551, 10.190], 0.246) at the 36-month follow-up. HbA1c levels were positively correlated with ROC, but the adverse cardiovascular events were driven by elevated HbA1c, constituting an argument to intensify glycemic control in subjects with diabetes after intracoronary stent placement.
本研究旨在探讨糖化血红蛋白（HbA1c）对接受药物洗脱支架植入术的患者血小板反应性和心血管结局的影响。将 HbA1c 水平分为 3 组：<6.5%、6.5-8.5%和>8.5%。计算了抵抗氯吡格雷（ROA）和抵抗阿司匹林（ROC）的比值。主要终点是包括全因死亡率、非致死性心肌梗死和缺血驱动血运重建的复合终点不良事件（MACE）。次要终点包括每个 MACE 成分。ROC 的发生率为 9.3%（151/1621），而 ROA 的发生率为 16.5%（268/1621）。随着 HbA1c 水平的升高，每组的 ROC 均显著增加[4.3%、7.1%和 10.1%，p=0.006]；然而，ROA 没有增加[16.4%、17.7%和 14.3%，P=0.694]。HbA1c>8.5 与 ROC 显著相关（3.356 [1.231, 9.234]，p=0.009）。与 HbA1c<6.5 亚组相比，HbA1c˃8.5 亚组与 MACE（3.142 [2.346, 4.206]，<0.001）、非致死性心肌梗死（2.297 [1.275, 4.137]，P=0.006）和缺血驱动的血运重建（3.845 [2.082, 7.101]，p<0.001）显著相关，但与全因死亡率（2.371 [0.551, 10.190]，0.246）在 36 个月的随访中无显著相关性。HbA1c 水平与 ROC 呈正相关，但不良心血管事件是由 HbA1c 升高驱动的，这表明在冠状动脉内支架植入后，糖尿病患者应加强血糖控制。
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