Influence of Baseline HbA1c and Antiplatelet Therapy on 1-Year Vein Graft Outcome

Yunpeng Zhu; Junlong Hu; Minlu Zhang; Qing Xue; Hao Liu; Rui Wang; Xiaowei Wang; Zhaoyun Cheng; Qiang Zhao

doi:10.1016/j.jacasi.2021.11.009

Influence of Baseline HbA1c and Antiplatelet Therapy on 1-Year Vein Graft Outcome

JACC Asia. 2022 Mar 15;2(2):197-206. doi: 10.1016/j.jacasi.2021.11.009. eCollection 2022 Apr.

Authors

Yunpeng Zhu¹, Junlong Hu², Minlu Zhang³, Qing Xue⁴, Hao Liu⁵, Rui Wang⁶, Xiaowei Wang⁷, Zhaoyun Cheng², Qiang Zhao¹

Affiliations

¹ Department of Cardiovascular Surgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² Department of Cardiovascular Surgery, Henan Provincial People's Hospital Heart Center, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China.
³ Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China.
⁴ Department of Cardiovascular Surgery, Changhai Hospital of Shanghai, Shanghai, China.
⁵ Department of Cardiothoracic Surgery, Xinhua Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁶ Department of Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
⁷ Department of Cardiovascular Surgery, Jiangsu Province Hospital, Nanjing, China.

Abstract

Background: The influence of baseline HbA1c levels on vein graft outcomes post coronary artery bypass grafting (CABG) remains unclear.

Objective: The purpose of this study was to assess the association between baseline HbA1c and 1-year vein graft patency, and the effects of antiplatelet therapy on the 1-year vein graft patency after CABG in patients with baseline HbA1c <6.5% vs ≥6.5%.

Methods: We examined the subgroups with baseline HbA1c <6.5% vs ≥6.5% from the DACAB trial (NCT02201771), in which 500 patients were randomly allocated to receive ticagrelor plus aspirin (T+A), ticagrelor alone (T), or aspirin alone (A) for 1 year after CABG. The primary outcome was the vein graft patency (FitzGibbon grade A) at 1 year.

Results: A total of 405 patients with available baseline HbA1c data were included in this subgroup analysis. Of them, there were 233 patients (678 vein grafts) with baseline HbA1c <6.5% and 172 patients (512 vein grafts) with baseline HbA1c ≥6.5%. Compared with the HbA1c <6.5% subgroup, the HbA1c ≥6.5% subgroup showed worse 1-year vein graft patency (adjusted odds ratio [OR] for nonpatency: 1.69, 95% confidence interval [CI]: 1.08-2.64). T+A showed higher vein graft patency than A in both HbA1c <6.5% (adjusted OR for nonpatency: 0.34, 95% CI: 0.15-0.75) and HbA1c ≥6.5% subgroups (adjusted OR for nonpatency: 0.45, 95% CI: 0.19-1.09), without an interaction effect (P for interaction = 0.335), whereas T did not show more significant improvement than A in both subgroups.

Conclusions: In the DACAB trial, lower baseline HbA1c was associated with higher vein graft patency 1 year after CABG. T+A improved 1-year vein graft patency vs A, irrespective of baseline HbA1c.

Keywords: CABG, coronary artery bypass graft; CAD, coronary artery disease; CI, confidence interval; DM, diabetes mellitus; HbA1c, glycated hemoglobin; ITT, intention to treat; MACE, major adverse cardiovascular event; OR, odds ratio; T+A, ticagrelor plus aspirin; aspirin; coronary artery bypass grafting; glycated hemoglobin A; patency; ticagrelor; vein graft.