Prevalence and in-hospital outcomes of diabetes among patients with acute coronary syndrome in China: findings from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome Project

Cong

Zhang

et al. 2020

Preprint

Background: Triglyceride-glucose index (TyG index) has been regarded as a reliable alternative marker of insulin resistance and an independent predictor of cardiovascular outcomes. Whether TyG index predicts adverse cardiovascular events in patients with diabetes and acute coronary syndrome (ACS) remains uncertain. The aim of the present study was to investigate the prognostic value of TyG index in patients with diabetes and ACS.Methods: A total of 2531 consecutive patients with diabetes who underwent coronary angiography for ACS were enrolled in the study. Patients were divided into 3 tertiles according to TyG index. The primary outcomes included the occurrence of major adverse cardiovascular events (MACE), defined as all-cause death, non-fatal myocardial infarction and non-fatal stroke. The TyG index was calculated as ln (fasting triglyceride level (mg/dL) ×fasting glucose level (mg/dL)/2).Results: The incidence of MACE increased with TyG index tertiles after 3-year follow-up. Kaplan-Meier curves showed significant differences in event-free survival rates among TyG index tertiles (P=0.005).Multivariate Cox hazards regression analysis revealed that TyG index was an independent predictor of MACE (95% CI 1.201-1.746; P<0.001). The optimal TyG index cut-off for predicting MACE was 9.323 (sensitivity 46.0% ; specificity 63.6%; area under the curve 0.560; P=0.001 ).Furthermore, adding TyG index to the prognostic model for MACE improved the C-statistic value (P=0.010), the integrated discrimination improvement value(P=0.001) and the net reclassification improvement value(P=0.019).Conclusions TyG index predicts future recurrent cardiovascular events in patients with diabetes and ACS, independently of known cardiovascular risk factors suggesting that TyG index may be a useful marker for risk stratification and prognosis in patients with diabetes and ACS.

Section: Introductionmentioning

confidence: 99%

“…Compared with those without diabetes, patients with diabetes and ACS remain at higher risk for recurrent ischemic cardiovascular events (CVEs) despite optimal treatment according to current guidelines [2][3][4]. Therefore, it is crucial to identify patients at high risk of developing future CVEs so that intense treatment can be provided.…”

Section: Introductionmentioning

confidence: 99%

Triglyceride-glucose index predicts adverse cardiovascular events in patients with diabetes and acute coronary syndrome

Cong

Zhang

et al. 2020

Preprint

“…Among Chinese patients with ACS, 37.6% accompanied diabetes or possible diabetes. Even in patients with diabetes younger than 45 years old, 26.9% accompanied by diabetes or possible diabetes 9 . There are few large-scale research to explore the mortality associated with different duration use of clopidogrel in patients with diabetes and ACS undergoing PCI in the Chinese population.…”

Section: Introductionmentioning

confidence: 99%

Treatment Outcomes of Clopidogrel in Patients With ACS and Diabetes Undergoing PCI-analysis of Beijing Medicare Database

Zhang

et al. 2020

Preprint

Background There are several clinical trials that proved the efficacy of clopidogrel treatment for patients with percutaneous coronary intervention. There are few large-scale research to explore the mortality associated with different duration use of clopidogrel in patients with diabetes and ACS undergoing PCI in the Chinese population. Objectives The objective of this analysis was to determine the efficacy of long-term clopidogrel therapy(≥ 12 months) versus short-term use(< 12 months) in Chinese patients with diabetes after PCI. Methods Using the Beijing Medicare database provided by Beijing Medical Security Bureau. The Beijing Medicare database contains medical data of about 16 million people, including about 990,000 patients with diabetes and a history of taking antidiabetic medicines. Patients were divided into two groups, one group of 9,116 patients receiving consecutive clopidogrel for one year or more, and another group of 3290 patients receiving consecutive clopidogrel less than one year. The primary of this analysis was the risk of all-cause death, myocardial infarction and revascularization. Results In patients with diabetes after PCI, long-term clopidogrel treatment was associated with a reduced risk of all-cause death(HR, 0.57[95%CI, 0.49–0.67], P < 0.0001), myocardial infarction(HR, 0.79[95%CI, 0.68–0.93], P = 0.0035) and an increased risk of angina(HR, 1.18[95%CI, 1.10–1.27], P < 0.0001]) and revascularization(HR, 1.07[95%CI, 1.01–1.13], P = 0.02]). There was no significant difference in the incidence of all-cause re-hospitalization(P = 0.7529), diabetes-related re-hospitalization and cerebrovascular re-hospitalization. Conclusion The present study concluded that long-term dual anti-platelet therapy including clopidogrel and aspirin could decrease the risks of all-cause death, myocardial infarction. But it could increase the risks of angina and revascularization. Further studies should interpret the cause of this question.

“…Acute coronary syndrome (ACS) is an acute manifestation of cardiovascular disease with a high risk of mortality that can lead to critical conditions such as cardiogenic shock and cardiac arrest. Patients with ACS and diabetes usually have worse clinical outcomes than those with normal blood glucose [2][3][4][5][6][7][8], regardless of in-hospital or long-term outcomes.…”

Section: Introductionmentioning

confidence: 99%

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

Yang

et al. 2020

Preprint

Self Cite

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.