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Thorac Cardiovasc Surg 2023; 71(06): 469-482
DOI: 10.1055/s-0042-1748768
Original Cardiovascular

The Association between Glycosylated Hemoglobin Level and Platelets Reactivity in Patients with Diabetes Mellitus Undergoing Elective Coronary Artery Bypass Grafting

Martina Zrno Mihaljevic 
1   Department of Cardiovascular Diseases, University Hospital Centre Zagreb, University of Zagreb, Zagreb, Croatia
,
Mate Petricevic 
2   Department of Cardiac Surgery, University Department of Health Studies, University of Split, UHC Zagreb, Split, Croatia
,
Sanja Konosic
3   Department of Anesthesiology, University Clinical Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
,
Lucija Svetina
4   Department of Cardiac Surgery, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
,
Marjan Urlic
1   Department of Cardiovascular Diseases, University Hospital Centre Zagreb, University of Zagreb, Zagreb, Croatia
,
Zrinka Starcevic
1   Department of Cardiovascular Diseases, University Hospital Centre Zagreb, University of Zagreb, Zagreb, Croatia
,
Kristina Krzelj
4   Department of Cardiac Surgery, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
,
Milan Milosevic
5   Andrija Stampar Teaching Institute of Public Health, Zagreb, Croatia
,
Viktor Kalamar
6   Department of Thoracic Surgery, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
,
Hrvoje Gasparovic 
4   Department of Cardiac Surgery, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
,
Bojan Biocina
7   Department of Cardiac Surgery, University Clinical Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
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Abstract

Background Diabetic patients tend to have increased platelet reactivity after coronary artery bypass grafting (CABG). The aim of this study was to determine the association between hemoglobin A1c (HbA1c) values and platelet reactivity and to evaluate the consequent impact on clinical outcomes in patients undergoing CABG.

Methods This prospective observational trial consecutively enrolled 225 diabetic patients undergoing CABG, between February 2014 and October 2018. HbA1c levels and platelet function (multiple electrode aggregometry [MEA]) were analyzed the day before surgery and on postoperative day 4 (POD 4). Patients were divided into two groups according to the HbA1c value: HBA1c < 7% and HbA1c ≥ 7%.

Results Significantly higher postoperative ASPI (platelet function test based on arachidonic acid) and ADP (platelet function test based on adenosine diphosphate) test values were observed at POD 4 compared with preoperative values (ASPI test: p < 0.001; ADP test: p < 0.001). The prevalence of preoperative aspirin resistance (AR) was 46.4% relative to 57.2% after surgery showing consistent increase in postoperative AR by approximately 10%. In addition, the prevalence of AR in the HbA1c < 7% group was higher by 10% compared with the HbA1c ≥ 7% group, both before and after surgery. We did not demonstrate differences in clinical outcomes between the HbA1c groups.

Conclusion Perioperative assessment of platelet reactivity in diabetic patients detects those with AR who may be at increased risk of adverse ischemic events. A personalized approach guided by MEA and administration of early and more potent antiaggregation therapy after CABG can be beneficial in this group of patients.

Keywords

coronary artery bypass grafting - HbA1c - multiple electrode aggregometry - aspirin resistance

Authors' Contribution

M.Z.M., M.P., S.K., M.U., H.G., B. B. contributed most to the work, including drafting the manuscript and revising it critically for important intellectual content. M.Z.M., M.P., S.K., L.S., M.M., H.G., B.B. made Substantial contributions to the Conception or design of the work. M.Z.M., M.P., S.K. L.S., Z.S., V.K., H.G., B.B. contributed to Literature overview, data acquisition, analysis, and interpretation of data. M.Z.M., M.P., M.U., Z.S., M.M., H.G., B.B. contributed to the Figures. All authors drafted the work for important intellectual content and approved the final version and are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.




Publication History

Received: 29 November 2021

Accepted: 29 March 2022

Article published online:
25 June 2022

© 2022. Thieme. All rights reserved.

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