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High glycated albumin is an independent predictor of low response to clopidogrel in ACS patients: a cross-sectional study

BACKGROUND: Glycated albumin (GA) is a marker of short-term glycemic control and is strongly associated with the occurrence of diabetes. Previous studies have shown an association between GA and the effect of clopidogrel therapy on ischemic stroke. However, limited information is available regarding...

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Autores principales: Zhao, Xiliang, Li, Quan, Tu, Chenchen, Zeng, Yong, Ye, Yicong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7545941/
https://www.ncbi.nlm.nih.gov/pubmed/33036613
http://dx.doi.org/10.1186/s12933-020-01146-w
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author Zhao, Xiliang
Li, Quan
Tu, Chenchen
Zeng, Yong
Ye, Yicong
author_facet Zhao, Xiliang
Li, Quan
Tu, Chenchen
Zeng, Yong
Ye, Yicong
author_sort Zhao, Xiliang
collection PubMed
description BACKGROUND: Glycated albumin (GA) is a marker of short-term glycemic control and is strongly associated with the occurrence of diabetes. Previous studies have shown an association between GA and the effect of clopidogrel therapy on ischemic stroke. However, limited information is available regarding this relationship in acute coronary syndrome (ACS) patients. In this study, we evaluated the effect of GA on platelet P2Y12 inhibition by clopidogrel in patients with ACS. METHODS: Consecutive Chinese patients with ACS who received loading or maintenance doses of clopidogrel in addition to aspirin were recruited. At least 12 h after the patient had taken the clopidogrel dose, thromboelastography (TEG) and light transmittance aggregometry (LTA) were used to calculate the quantitative platelet inhibition rate to determine clopidogrel-induced antiplatelet reactivity. A prespecified cutoff of the maximum amplitude of adenosine diphosphate (ADP)-induced platelet-fibrin clot strength > 47 mm plus an ADP-induced platelet inhibition rate < 50% assessed by TEG or ADP-induced platelet aggregation > 40% assessed by LTA to indicate low responsiveness to clopidogrel were applied for evaluation. Patients were categorized into two groups based on a GA level of 15.5%, the cutoff point indicating the development of early-phase diabetes. Multivariate linear regression analysis was used to assess the interaction of GA with clopidogrel antiplatelet therapy. RESULTS: A total of 1021 participants were evaluated, and 28.3% of patients (289 of 1021) had low responsiveness to clopidogrel assessed by TEG. In patients with elevated GA levels, low responsiveness to clopidogrel assessed by TEG was observed in 33.7% (139 of 412) of patients, which was a significantly higher rate than that in the lower-GA-level group (24.6%, P = 0.002). According to multivariate linear regression analysis, a GA level > 15.5% was independently associated with low responsiveness to clopidogrel after adjustment for age, sex and other conventional confounding factors. This interaction was not mediated by a history of diabetes mellitus. A GA level ≤ 15.5% was associated with a high positive value [75.4%, 95% CI 73.0–77.6%] for predicting a normal responsiveness to clopidogrel. CONCLUSIONS: GA could be a potential biomarker to predict the effects of clopidogrel antiplatelet therapy in ACS patients and might be a clinical biomarker to guide DAPT de-escalation.
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spelling pubmed-75459412020-10-13 High glycated albumin is an independent predictor of low response to clopidogrel in ACS patients: a cross-sectional study Zhao, Xiliang Li, Quan Tu, Chenchen Zeng, Yong Ye, Yicong Cardiovasc Diabetol Original Investigation BACKGROUND: Glycated albumin (GA) is a marker of short-term glycemic control and is strongly associated with the occurrence of diabetes. Previous studies have shown an association between GA and the effect of clopidogrel therapy on ischemic stroke. However, limited information is available regarding this relationship in acute coronary syndrome (ACS) patients. In this study, we evaluated the effect of GA on platelet P2Y12 inhibition by clopidogrel in patients with ACS. METHODS: Consecutive Chinese patients with ACS who received loading or maintenance doses of clopidogrel in addition to aspirin were recruited. At least 12 h after the patient had taken the clopidogrel dose, thromboelastography (TEG) and light transmittance aggregometry (LTA) were used to calculate the quantitative platelet inhibition rate to determine clopidogrel-induced antiplatelet reactivity. A prespecified cutoff of the maximum amplitude of adenosine diphosphate (ADP)-induced platelet-fibrin clot strength > 47 mm plus an ADP-induced platelet inhibition rate < 50% assessed by TEG or ADP-induced platelet aggregation > 40% assessed by LTA to indicate low responsiveness to clopidogrel were applied for evaluation. Patients were categorized into two groups based on a GA level of 15.5%, the cutoff point indicating the development of early-phase diabetes. Multivariate linear regression analysis was used to assess the interaction of GA with clopidogrel antiplatelet therapy. RESULTS: A total of 1021 participants were evaluated, and 28.3% of patients (289 of 1021) had low responsiveness to clopidogrel assessed by TEG. In patients with elevated GA levels, low responsiveness to clopidogrel assessed by TEG was observed in 33.7% (139 of 412) of patients, which was a significantly higher rate than that in the lower-GA-level group (24.6%, P = 0.002). According to multivariate linear regression analysis, a GA level > 15.5% was independently associated with low responsiveness to clopidogrel after adjustment for age, sex and other conventional confounding factors. This interaction was not mediated by a history of diabetes mellitus. A GA level ≤ 15.5% was associated with a high positive value [75.4%, 95% CI 73.0–77.6%] for predicting a normal responsiveness to clopidogrel. CONCLUSIONS: GA could be a potential biomarker to predict the effects of clopidogrel antiplatelet therapy in ACS patients and might be a clinical biomarker to guide DAPT de-escalation. BioMed Central 2020-10-09 /pmc/articles/PMC7545941/ /pubmed/33036613 http://dx.doi.org/10.1186/s12933-020-01146-w Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Original Investigation
Zhao, Xiliang
Li, Quan
Tu, Chenchen
Zeng, Yong
Ye, Yicong
High glycated albumin is an independent predictor of low response to clopidogrel in ACS patients: a cross-sectional study
title High glycated albumin is an independent predictor of low response to clopidogrel in ACS patients: a cross-sectional study
title_full High glycated albumin is an independent predictor of low response to clopidogrel in ACS patients: a cross-sectional study
title_fullStr High glycated albumin is an independent predictor of low response to clopidogrel in ACS patients: a cross-sectional study
title_full_unstemmed High glycated albumin is an independent predictor of low response to clopidogrel in ACS patients: a cross-sectional study
title_short High glycated albumin is an independent predictor of low response to clopidogrel in ACS patients: a cross-sectional study
title_sort high glycated albumin is an independent predictor of low response to clopidogrel in acs patients: a cross-sectional study
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7545941/
https://www.ncbi.nlm.nih.gov/pubmed/33036613
http://dx.doi.org/10.1186/s12933-020-01146-w
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