See the published version of this preprint at BMC Cardiovascular Disorders.
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Research article
Hong Cheng
Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases
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
BackgroundThe 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.
MethodsThe 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).
ResultsA total of 7,762 patients were included in this study. The numbers of patients in the consistent and discrepancy groups 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) 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.
Keywords
acute coronary syndrome, diabetes, fasting plasma glucose, glycosylated hemoglobin
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This is a list of supplementary files associated with this preprint. Click to download.
- Additionalfile1clean.pdf
Additional file 1.pdf: Table S1. Variables with missing values and missing rates for total population in the CCC - ACS project (N=92509). Table S2. Prevalence of discrepancies in different populations. Table S3. Logistic regression analysis for in-hospital outcomes in the increased FPG group compared with the increased HbA1c group. Table S4. Investigators of the CCC-ACS project. Figure S1. Flow chart of patients considered for inclusion. Figure S2. Association between discrepancy and renal function.
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CURRENT STATUS: Published
View the published article at BMC Cardiovascular Disorders.
Version 3
Posted 04 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
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
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Subject Areas
Cardiac & Cardiovascular Systems
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See the published version of this preprint at BMC Cardiovascular Disorders.
This is a preprint, 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
Hong Cheng
Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases
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
View the published article at BMC Cardiovascular Disorders.
Version 3
Posted 04 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
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 article at BMC Cardiovascular Disorders.
BackgroundThe 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.
MethodsThe 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).
ResultsA total of 7,762 patients were included in this study. The numbers of patients in the consistent and discrepancy groups 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) 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.
Figure 1
Figure 2
Figure 3
This is a list of supplementary files associated with this preprint. Click to download.
- Additionalfile1clean.pdf
Additional file 1.pdf: Table S1. Variables with missing values and missing rates for total population in the CCC - ACS project (N=92509). Table S2. Prevalence of discrepancies in different populations. Table S3. Logistic regression analysis for in-hospital outcomes in the increased FPG group compared with the increased HbA1c group. Table S4. Investigators of the CCC-ACS project. Figure S1. Flow chart of patients considered for inclusion. Figure S2. Association between discrepancy and renal function.
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