Admission fasting plasma glucose is associated with in-hospital outcomes in patients with acute coronary syndrome and diabetes: findings from the improving Care for Cardiovascular Disease in China - Acute Coronary Syndrome (CCC-ACS) project

Nan Ye, Lijiao Yang, Guoqin Wang, Weijing Bian, Fengbo Xu, Changsheng Ma, Dong Zhao, Jing Liu, Yongchen Hao, Jun Liu, Na Yang, Hong Cheng, CCC-ACS, Nan Ye, Lijiao Yang, Guoqin Wang, Weijing Bian, Fengbo Xu, Changsheng Ma, Dong Zhao, Jing Liu, Yongchen Hao, Jun Liu, Na Yang, Hong Cheng, CCC-ACS

Abstract

Background: The discrepancy between glycosylated hemoglobin (HbA1c) and fasting plasma glucose (FPG) in clinical practice may be related to factors such as acute stress, renal dysfunction, and anemia, and its relationship with in-hospital outcomes is uncertain. The aim of this study was to investigate the association between the type of discrepancy between HbA1c and FPG and in-hospital outcomes in patients with acute coronary syndrome (ACS) and diabetes.

Methods: The Improving Care for Cardiovascular Disease in China - Acute Coronary Syndrome (CCC-ACS) project is a national, hospital-based quality improvement project with an ongoing database. Patients with ACS, diabetes and complete HbA1c and FPG values at admission were included. The consistent group included patients with HbA1c < 6.5% and FPG < 7.0 mmol/L or HbA1c ≥ 6.5% and FPG ≥ 7.0 mmol/L. The discrepancy group included patients with HbA1c ≥ 6.5% and FPG < 7.0 mmol/L (increased HbA1c group) or HbA1c < 6.5% and FPG ≥ 7.0 mmol/L (increased FBG group).

Results: A total of 7762 patients were included in this study. The numbers of patients in the consistent and discrepancy groups were 5490 and 2272 respectively. In the discrepancy group, increased HbA1c accounted for 77.5% of discrepancies, and increased FPG accounted for 22.5% of discrepancies. After adjusting for confounders, patients in the increased FPG group had a 1.6-fold increased risk of heart failure (OR, 1.62; 95% CI, 1.08-2.44), a 1.6-fold increased risk of composite cardiovascular death and heart failure (OR, 1.63; 95% CI, 1.09-2.43), and a 1.6-fold increased risk of composite major adverse cardiovascular and cerebrovascular events (MACCEs) and heart failure (OR, 1.56; 95% CI, 1.08-2.24) compared to patients in the increased HbA1c group.

Conclusions: Patients with an increased FPG but normal HbA1c had a higher risk of in-hospital adverse outcomes than those with increased HbA1c but normal FPG. This result may indicate that when HbA1c and FPG are inconsistent in patients with ACS and diabetes, the increased FPG that may be caused by stress hyperglycemia may have a more substantial adverse effect than increased HbA1c, which may be caused by chronic hyperglycemia. These high-risk patients should be given more attention and closer monitoring in clinical practice.

Trial registry: Clinicaltrial.gov , NCT02306616 . Registered 29 November 2014.

Keywords: Acute coronary syndrome; Diabetes; Fasting plasma glucose; Glycosylated hemoglobin.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Prevalence of discrepancy in different population. eGFR, estimated glomerular filtration rate; FPG, fasting plasma glucose; HbA1c, glycosylated hemoglobin; NSTE-ACS, non-ST-segment elevation acute coronary syndrome; STEMI, ST-segment elevation myocardial infarction
Fig. 2
Fig. 2
In-hospital outcomes in patients with discrepancy between HbA1c and FPG. FPG, fasting plasma glucose; HbA1c, glycosylated hemoglobin; MACCE, major adverse cardiovascular and cerebrovascular event
Fig. 3
Fig. 3
Subgroup analysis for association between the type of discrepancy and in-hospital outcomes*. * A categorized variable to compare the increased FPG group with the increased HbA1c group was used in logistic regression analysis. ORs were adjusted for age, gender, systolic blood pressure, heart rate, current smoker, hypertension, hemoglobin at admission, eGFR at admission, Killip class, type of acute coronary syndrome, and glucose-lowering drug use. Panel a shows the effect of the increased FPG group on MACCE compared with increased HbA1c group. Panel b shows the effect of the increased FPG group on heart failure compared with increased HbA1c group. eGFR, estimated glomerular filtration rate; FPG, fasting plasma glucose; HbA1c, glycosylated hemoglobin; MACCE, major adverse cardiovascular and cerebrovascular event; NSTE-ACS, non-ST-segment elevation acute coronary syndrome; STEMI, ST-segment elevation myocardial infarction
Fig. 4
Fig. 4
Panel c shows the effect of the increased FPG group on the composite of cardiovascular death and heart failure compared with the increased HbA1c group. Panel d shows the effect of the increased FPG group on the composite of MACCE and heart failure compared with the increased HbA1c group. eGFR, estimated glomerular filtration rate; FPG, fasting plasma glucose; HbA1c, glycosylated hemoglobin; MACCE, major adverse cardiovascular and cerebrovascular event; NSTE-ACS, non-ST-segment elevation acute coronary syndrome; STEMI, ST-segment elevation myocardial infarction

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Source: PubMed

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