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

Abstract

Background The aim of this study is to investigate the association between types of discrepancy between glycosylated hemoglobin (HbA1c) and fasting plasma glucose (FPG) and in-hospital outcomes in patients with acute coronary syndrome (ACS) and diabetes, based on Improving Care for Cardiovascular Disease in China - acute coronary syndrome project. MethodsCCC-ACS project is a national, hospital-based quality improvement project. Patients with ACS, diabetes and complete HbA1c and FBG value at admission were included in this study. Patients were divided into consistent group and discrepancy group based on the HbA1c and FBG value at admission. Consistent group included patients with HbA1c < 6.5% and FBG < 7.0 mmol/L, or patients with HbA1c ≥ 6.5% and FBG ≥ 7.0 mmol/L. Discrepancy group included patients with HbA1c ≥ 6.5% and FBG < 7.0 mmol/L, or patients with HbA1c < 6.5% and FBG ≥ 7.0 mmol/L. Discrepancy group was further divided into increased HbA1c group (HbA1c ≥ 6.5% and FBG < 7.0 mmol/L) and increased FBG group (HbA1c < 6.5% and FBG ≥ 7.0 mmol/L).ResultsA total of 7,762 patients were included in this study. Patients in consistent group and discrepancy group were 5,490 (70.7%) and 2,272 (29.3%) respectively. In discrepancy group, increased HbA1c group accounted for 77.5% (1,761/2,272), and increased FPG group accounted for 22.5% (511/2,272). After adjusting for confounders by multivariate logistic regression model, patients in increased FPG group had a significantly 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 of cardiovascular death and heart failure (OR, 1.63; 95% CI, 1.09-2.43), and a 1.6-fold increased risk of composite of MACCE and heart failure (OR, 1.56; 95% CI, 1.08-2.24).Conclusions Patients with an increased level of FPG but normal HbA1c had a higher risk of in-hospital cardiovascular adverse outcomes than those with an increased level of HbA1c but normal FPG. These patients should be given more attention and closer monitoring in clinical practice in order to improve the in-hospital outcomes.