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Observational Study
. 2021 Sep;46(Suppl 2):287-294.
doi: 10.1007/s00059-020-04999-9. Epub 2020 Nov 24.

Clinical significance of glycated hemoglobin in acute coronary syndrome patients from the CCC-ACS project : Findings from a multicenter retrospective observational study

Xin Zhao  1 , Yi Kang  2 , Xiaozeng Wang  1 , Xiaoxu Yang  3 , Guannan Ai  1   4 , Yifei Liu  1   4 , Pei Xu  1   4 , Jiyuan Zhang  1   4 , Chonghuai Gu  5 , Yan Zhang  6 , Yongchen Hao  7 , Dong Zhao  7 , Yaling Han  8 ; CCC investigators
Affiliations
Observational Study

Clinical significance of glycated hemoglobin in acute coronary syndrome patients from the CCC-ACS project : Findings from a multicenter retrospective observational study

Xin Zhao et al. Herz. 2021 Sep.

Abstract
in English, German

Background: Blood glucose levels are associated with the prognosis of patients with acute coronary syndrome (ACS). Glycated hemoglobin (HbA1c) reflects the average blood glucose level. The purpose of the study was to evaluate HbA1c as a prognostic indicator for ACS.

Methods: In total, 27,337 ACS patients from the CCC-ACS (Improving Care for Cardiovascular Disease in China - Acute Coronary Syndrome) project were enrolled in this study and divided into three groups according to HbA1c level: Group I, HbA1c level <5.7%; Group II, HbA1c level 5.7-6.4%; Group III, HbA1c level ≥6.5%. The primary outcome was an in-hospital major adverse cardiovascular event (MACE), such as all-cause death, recurrent myocardial infarction, acute or subacute stent thrombosis, heart failure, cardiogenic shock, or cardiac arrest. Baseline data and effectiveness outcome were compared among patients in the three groups.

Results: Group III had the highest MACE incidence (13.4% [Group III] vs. 8.7% [Group I] and 10.5% [Group II], p < 0.001). In the logistic regression, there was a statistically significant difference in HbA1c level between the groups (odds ratio [OR]: 1.110, 95% confidence interval [CI]: 1.008-1.133, p < 0.001). In the receiver operating characteristic curve, the area under the curve for MACE was 0.560 (95% CI: 0.550-0.571, p < 0.001); the cut-off value for the HbA1c level was 6.38%.

Conclusion: The HbA1c level was associated with the risk of MACEs in ACS patients with or without diabetes. Trial Registration clinicaltrials.gov, NCT02306616. Registered 3 December 2014-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02306616 .

Zusammenfassung: HINTERGRUND: Der Blutzuckerspiegel steht in einem Zusammenhang mit der Prognose von Patienten mit akutem Koronarsyndrom (ACS). Das glykierte Hämoglobin (HbA1c) ist ein Marker für den durchschnittlichen Blutzuckerspiegel. Ziel der vorliegenden Studie war es, HbA1c als prognostischen Indikator des ACS zu untersuchen.

Methoden: In die vorliegende Studie wurden 27.337 ACS-Patienten aus dem CCC-ACS-Projekt (Improving Care for Cardiovascular Disease in China – Acute Coronary Syndrome) einbezogen und nach ihrem HbA1c-Wert in 3 Gruppen eingeteilt: Gruppe I mit einem HbA1c-Wert <5,7 %; Gruppe II mit einem HbA1c-Wert von 5,7–6,4 %; Gruppe III mit einem HbA1c-Wert ≥6,5 %. Primärer Endpunkt war ein schweres kardiovaskuläres unerwünschtes Ereignis im Krankenhaus (MACE), wie Tod aus sämtlichen Ursachen, Rezidiv eines Herzinfarkts, akute oder subakute Stentthrombose, Herzinsuffizienz, kardiogener Schock oder Herzstillstand. Die Ausgangsdaten und das Ergebnis hinsichtlich der Wirksamkeit wurden zwischen den Patienten in den 3 Gruppen verglichen.

Ergebnisse: Die höchste MACE-Inzidenz bestand in Gruppe III (13,4 % [Gruppe III] vs. 8,7 % [Gruppe I] und 10,5 % [Gruppe II]; p < 0,001). Im Rahmen der logistischen Regression gab es zwischen den Gruppen eine statistisch signifikante Differenz beim HbA1c-Wert (Odds Ratio, OR: 1,110; 95 %-Konfidenzintervall, 95 %-KI: 1,008–1,133; p < 0,001). In der Receiver-Operating-Characteristic-Kurve betrug die Fläche unter der Kurve für MACE 0,560 (95 %-KI: 0,550–0,571; p < 0,001); der Grenzwert für den HbA1c-Wert lag bei 6,38 %.

Schlussfolgerung: Der HbA1c-Wert weist einen Zusammenhang mit dem Risiko für MACE bei ACS-Patienten mit oder ohne Diabetes mellitus auf. Studienregistrierung: clinicaltrials.gov, NCT02306616. Registrierung 3. Dezember 2014 – retrospektiv registriert, https://clinicaltrials.gov/ct2/show/NCT02306616 .

Keywords: Blood glucose; Diabetes mellitus; Glycated hemoglobin; Myocardial ischemia; Prognosis.

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