Preoperative HbA1c >6.5% was associated with significantly higher 5-year all-cause mortality compared to HbA1c ≤6.5% after CABG (adjusted HR 2.08; 95% CI 1.10-3.96).
RCT (n=467)
randomized
Does ticagrelor plus aspirin or ticagrelor alone improve 5-year clinical outcomes compared to aspirin alone after CABG across different preoperative HbA1c levels?
Lower preoperative HbA1c is associated with improved 5-year survival after CABG, and 1-year dual antiplatelet therapy with ticagrelor and aspirin reduces 5-year MACE risk compared to aspirin alone regardless of baseline HbA1c.
Effect estimate: adjusted HR 2.08 (95% CI 1.10-3.96)
Abstract Background The influence of baseline HbA1c and dual antiplatelet therapy on the clinical outcomes post coronary artery bypass grafting (CABG) remains unclear. Objective The purpose of this study was to assess the association between preoperative HbA1c and 5-year clinical outcome, and the effects of antiplatelet therapy on the 5-year clinical outcomes after CABG in patients with preoperative HbA1c ≤6.5% vs 6.5%. Methods We examined the subgroups with preoperative HbA1c ≤6.5% vs 6.5% from the DACAB-Follow-up Extension (DACAB-FE) study (NCT03987373), in which 500 patients were randomized to receive ticagrelor plus aspirin (T+A), ticagrelor alone (T), or aspirin alone (A) for 1 year after CABG. Patients without any available HbA1C data were excluded. The outcomes of interest include major adverse cardiovascular events (MACE, a composite of all cause death, myocardial infarction, stroke, or coronary revascularization) and all-cause death. Time-to-event analysis was used to compare the risk between the subgroups. Results A total of 467 patients were included in this subgroup analysis. Of them, there were 293 patients with preoperative HbA1c ≤6.5% and 174 patients with preoperative HbA1c 6.5%. Follow-up at five years for MACE was completed for 447 (95.7%) of 467 patients. The 5-year all-cause mortality was significantly higher with HbA1c 6.5% versus HbA1c ≤6.5% (adjusted hazard ratio HR, 2.08; 95% confidence interval CI, 1.10-3.96). There was no significant difference in MACE (adjusted HR, 0.90; 95% CI, 0.63-1.28) between the two groups. T+A showed lower risk of MACE than A in both HbA1c ≤6.5% (adjusted HR: 0.69, 95% CI: 0.40-1.16) and HbA1c 6.5% subgroups (adjusted HR: 0.61, 95% CI: 0.29-1.26), without an interaction effect (P for interaction = 0.75), whereas T did not show more significant improvement than A in both HbA1c ≤6.5% (adjusted HR: 0.95, 95% CI: 0.58-1.56) and HbA1c 6.5% (adjusted HR: 1.06, 95% CI: 0.54-2.07) subgroups (P for interaction = 0.95). Conclusions In the DACAB-FE study, lower preoperative HbA1c was associated with improved survival 5 years after CABG. Regardless of the preoperative HbA1c level, dual antiplatelet therapy with T+A for one year reduced the risk of MACE at five years after CABG compared with A monotherapy.
Liu et al. (Sat,) conducted a rct in Post coronary artery bypass grafting (CABG) (n=467). Ticagrelor plus aspirin or ticagrelor alone vs. Aspirin alone was evaluated on 5-year all-cause mortality (adjusted HR 2.08, 95% CI 1.10-3.96). Preoperative HbA1c >6.5% was associated with significantly higher 5-year all-cause mortality compared to HbA1c ≤6.5% after CABG (adjusted HR 2.08; 95% CI 1.10-3.96).