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Research article
Type of discrepancy between glycosylated hemoglobin and 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
Hong Cheng
Corresponding Author
ORCiD: https://orcid.org/0000-0002-7908-3333
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Cardiovascular Disorders.
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 is 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 FBG values at admission were included. The consistent group included patients with HbA1c < 6.5% and FBG < 7.0 mmol/L or HbA1c ≥ 6.5% and FBG ≥ 7.0 mmol/L. The discrepancy group included patients with HbA1c ≥ 6.5% and FBG < 7.0 mmol/L (increased HbA1c group) or HbA1c < 6.5% and FBG ≥ 7.0 mmol/L (increased FBG group).
Results
A total of 7,762 patients were included in this study. The numbers of patients in the consistent group and discrepancy group were 5,490 and 2,272 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).
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.
Keywords
acute coronary syndrome, diabetes, fasting plasma glucose, glycosylated hemoglobin
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CURRENT STATUS: Published
Published
On 20 Aug, 2020
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Editorial decision: Accept
On 07 Aug, 2020
Editor assigned
On 27 Jul, 2020
Submission checks complete
On 26 Jul, 2020
Editor invited
On 26 Jul, 2020
No comments provided
Editorial decision: Minor revision
On 15 Jul, 2020
Review #1 received
Received 13 Jul, 2020
Reviewer #2 agreed
On 09 Jul, 2020
Review #2 received
Received 09 Jul, 2020
Reviewer #1 agreed
On 07 Jul, 2020
Reviewers invited
Invitations sent on 06 Jul, 2020
Editor assigned
On 05 Jul, 2020
Submission checks complete
On 04 Jul, 2020
Editor invited
On 04 Jul, 2020
Version 1
Posted 27 May, 2020
No comments provided
Editorial decision: Major revision
On 18 Jun, 2020
Review #2 received
Received 15 Jun, 2020
Review #1 received
Received 08 Jun, 2020
Reviewer #2 agreed
On 03 Jun, 2020
Reviewer #1 agreed
On 30 May, 2020
Reviewers invited
Invitations sent on 29 May, 2020
Editor assigned
On 20 May, 2020
Submission checks complete
On 19 May, 2020
Editor invited
On 19 May, 2020
First submitted
On 18 May, 2020
Metrics
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Subject Areas
Cardiac & Cardiovascular Systems
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This preprint is under consideration at BMC Cardiovascular Disorders. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Type of discrepancy between glycosylated hemoglobin and 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
Hong Cheng
Corresponding Author
ORCiD: https://orcid.org/0000-0002-7908-3333
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Published
On 20 Aug, 2020
No community comments so far
Editorial decision: Accept
On 07 Aug, 2020
Editor assigned
On 27 Jul, 2020
Submission checks complete
On 26 Jul, 2020
Editor invited
On 26 Jul, 2020
No comments provided
Editorial decision: Minor revision
On 15 Jul, 2020
Review #1 received
Received 13 Jul, 2020
Reviewer #2 agreed
On 09 Jul, 2020
Review #2 received
Received 09 Jul, 2020
Reviewer #1 agreed
On 07 Jul, 2020
Reviewers invited
Invitations sent on 06 Jul, 2020
Editor assigned
On 05 Jul, 2020
Submission checks complete
On 04 Jul, 2020
Editor invited
On 04 Jul, 2020
Version 1
Posted 27 May, 2020
No comments provided
Editorial decision: Major revision
On 18 Jun, 2020
Review #2 received
Received 15 Jun, 2020
Review #1 received
Received 08 Jun, 2020
Reviewer #2 agreed
On 03 Jun, 2020
Reviewer #1 agreed
On 30 May, 2020
Reviewers invited
Invitations sent on 29 May, 2020
Editor assigned
On 20 May, 2020
Submission checks complete
On 19 May, 2020
Editor invited
On 19 May, 2020
First submitted
On 18 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Cardiac & Cardiovascular Systems
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Cardiovascular Disorders.
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 is 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 FBG values at admission were included. The consistent group included patients with HbA1c < 6.5% and FBG < 7.0 mmol/L or HbA1c ≥ 6.5% and FBG ≥ 7.0 mmol/L. The discrepancy group included patients with HbA1c ≥ 6.5% and FBG < 7.0 mmol/L (increased HbA1c group) or HbA1c < 6.5% and FBG ≥ 7.0 mmol/L (increased FBG group).
Results
A total of 7,762 patients were included in this study. The numbers of patients in the consistent group and discrepancy group were 5,490 and 2,272 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).
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.
Figure 1
Figure 2
Figure 3