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
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 i...
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BMC
2020-08-01
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Series: | BMC Cardiovascular Disorders |
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Online Access: | http://link.springer.com/article/10.1186/s12872-020-01662-3 |
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Article |
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DOAJ |
language |
English |
format |
Article |
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DOAJ |
author |
Nan Ye Lijiao Yang Guoqin Wang Weijing Bian Fengbo Xu Changsheng Ma Dong Zhao Jing Liu Yongchen Hao Jun Liu Na Yang Hong Cheng on behalf of the CCC-ACS |
spellingShingle |
Nan Ye Lijiao Yang Guoqin Wang Weijing Bian Fengbo Xu Changsheng Ma Dong Zhao Jing Liu Yongchen Hao Jun Liu Na Yang Hong Cheng on behalf of the CCC-ACS 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 BMC Cardiovascular Disorders Acute coronary syndrome Diabetes Fasting plasma glucose Glycosylated hemoglobin |
author_facet |
Nan Ye Lijiao Yang Guoqin Wang Weijing Bian Fengbo Xu Changsheng Ma Dong Zhao Jing Liu Yongchen Hao Jun Liu Na Yang Hong Cheng on behalf of the CCC-ACS |
author_sort |
Nan Ye |
title |
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 |
title_short |
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 |
title_full |
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 |
title_fullStr |
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 |
title_full_unstemmed |
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 |
title_sort |
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 |
publisher |
BMC |
series |
BMC Cardiovascular Disorders |
issn |
1471-2261 |
publishDate |
2020-08-01 |
description |
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. |
topic |
Acute coronary syndrome Diabetes Fasting plasma glucose Glycosylated hemoglobin |
url |
http://link.springer.com/article/10.1186/s12872-020-01662-3 |
work_keys_str_mv |
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doaj-715864ec00f94bd4a4f1c88130be5e532020-11-25T03:12:00ZengBMCBMC Cardiovascular Disorders1471-22612020-08-0120111110.1186/s12872-020-01662-3Admission 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) projectNan Ye0Lijiao Yang1Guoqin Wang2Weijing Bian3Fengbo Xu4Changsheng Ma5Dong Zhao6Jing Liu7Yongchen Hao8Jun Liu9Na Yang10Hong Cheng11on behalf of the CCC-ACSRenal Division, Beijing Anzhen Hospital, Capital Medical UniversityRenal Division, Beijing Anzhen Hospital, Capital Medical UniversityRenal Division, Beijing Anzhen Hospital, Capital Medical UniversityRenal Division, Beijing Anzhen Hospital, Capital Medical UniversityRenal Division, Beijing Anzhen Hospital, Capital Medical UniversityDepartment of Cardiology, Beijing Anzhen Hospital, Capital Medical UniversityDepartment of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel DiseasesDepartment of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel DiseasesDepartment of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel DiseasesDepartment of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel DiseasesDepartment of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel DiseasesDepartment of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel DiseasesAbstract 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.http://link.springer.com/article/10.1186/s12872-020-01662-3Acute coronary syndromeDiabetesFasting plasma glucoseGlycosylated hemoglobin |