July 4, 2023Cardiovascular DiabetologyOpen Access

The impact of fasting stress hyperglycemia ratio, fasting plasma glucose and hemoglobin A1c on in-hospital mortality in patients with and without diabetes: findings from the China acute myocardial infarction registry

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute myocardial infarction (n=5308). Intervention: Fasting stress hyperglycemia ratio (SHR) vs. Lowest quartile of fasting SHR. Primary outcome: In-hospital mortality (Diabetic cohort, Quartile 4 vs Quartile 1) (OR 4.070, 95% CI 2.014-8.228).

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Key result

Being in the highest quartile of fasting stress hyperglycemia ratio significantly increased in-hospital mortality compared to the lowest quartile in both diabetic (OR 4.070) and nondiabetic (OR 2.976) patients with acute myocardial infarction.

Why the study?

Admission glucose and stress hyperglycemia ratio may not be the optimal indicators of stress hyperglycemia in acute myocardial infarction.

Does elevated fasting stress hyperglycemia ratio or fasting plasma glucose predict in-hospital mortality in patients with acute myocardial infarction with or without diabetes?

Population

5,308 AMI patients with and without diabetes

Comparison

Quartiles of fasting SHR vs FPG vs HbA1c

Design

Prospective nationwide multicenter registry

Authors

KCKongyong CuiChinese Academy of Medical Sciences & Peking Union Medical College RFRui FuNational Institutes for Food and Drug Control JYJingang YangSouthwest University

Discussion

Member takes

Implication

May aid in-hospital AMI risk stratification but should not change practice; leaves open whether fasting SHR outperforms FPG.

Study Design

Type

Cohort (n=5,308)

Multicenter

Yes

Structured PICO

Does elevated fasting stress hyperglycemia ratio or fasting plasma glucose predict in-hospital mortality in patients with acute myocardial infarction with or without diabetes?

Population

5,308 patients with acute myocardial infarction, including 2,081 with diabetes and 3,227 without diabetes, evaluated for in-hospital mortality based on admission glycemic markers.

Exposure

Highest quartile (Quartile 4) of fasting stress hyperglycemia ratio (SHR), fasting plasma glucose (FPG), or hemoglobin A1c (HbA1c) measured at admission.

Comparator

Lowest quartile (Quartile 1) of fasting SHR, FPG, or HbA1c.

Outcome

In-hospital mortality (cardiac or non-cardiac death during hospitalization), adjudicated by blinded medical personnel.hard clinical

Main Result

Odds Ratio: 4.07 (95% CI 2.014–8.228)

Absolute Event Rate: 9.7% vs 2%

Fasting stress hyperglycemia ratio and fasting plasma glucose are strong, independent predictors of in-hospital mortality in patients with acute myocardial infarction, regardless of their baseline diabetes status.

Limitations

Secondary analysis of a registry, making it impossible to control all confounding factors
Potential selection bias as only participants with FPG and HbA1c levels were included
Did not investigate the relationship between fasting SHR and in-hospital mortality in prediabetic patients exclusively
Did not compare the prognostic effect of fasting SHR and conventional SHR
Fasting SHR and FPG are derived from a single blood glucose test, which cannot reflect the full profile of glucose swings
Conclusions cannot be directly extrapolated to non-Asian populations without validation

Cite This Study

Cui et al. (2023) conducted a cohort in Acute myocardial infarction (n=5,308). Fasting stress hyperglycemia ratio (SHR) vs. Lowest quartile of fasting SHR was evaluated on In-hospital mortality (Diabetic cohort, Quartile 4 vs Quartile 1) (OR 4.070, 95% CI 2.014-8.228). Being in the highest quartile of fasting stress hyperglycemia ratio significantly increased in-hospital mortality compared to the lowest quartile in both diabetic (OR 4.070) and nondiabetic (OR 2.976) patients with acute myocardial infarction.

synapsesocial.com/papers/6a7f084deb525c734d9c41d2 https://doi.org/10.1186/s12933-023-01868-7

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July 4, 2023Cardiovascular DiabetologyOpen Access

The impact of fasting stress hyperglycemia ratio, fasting plasma glucose and hemoglobin A1c on in-hospital mortality in patients with and without diabetes: findings from the China acute myocardial infarction registry

View Full Paper

Ask AI

Bookmark

Key result

Why the study?

Admission glucose and stress hyperglycemia ratio may not be the optimal indicators of stress hyperglycemia in acute myocardial infarction.

Does elevated fasting stress hyperglycemia ratio or fasting plasma glucose predict in-hospital mortality in patients with acute myocardial infarction with or without diabetes?

Population

5,308 AMI patients with and without diabetes

Comparison

Quartiles of fasting SHR vs FPG vs HbA1c

Design

Prospective nationwide multicenter registry

Authors

KCKongyong CuiChinese Academy of Medical Sciences & Peking Union Medical College RFRui FuNational Institutes for Food and Drug Control JYJingang YangSouthwest University

Discussion

Member takes

Implication

May aid in-hospital AMI risk stratification but should not change practice; leaves open whether fasting SHR outperforms FPG.

Study Design

Type

Cohort (n=5,308)

Multicenter

Yes

Structured PICO

Does elevated fasting stress hyperglycemia ratio or fasting plasma glucose predict in-hospital mortality in patients with acute myocardial infarction with or without diabetes?

Population

5,308 patients with acute myocardial infarction, including 2,081 with diabetes and 3,227 without diabetes, evaluated for in-hospital mortality based on admission glycemic markers.

Exposure

Highest quartile (Quartile 4) of fasting stress hyperglycemia ratio (SHR), fasting plasma glucose (FPG), or hemoglobin A1c (HbA1c) measured at admission.

Comparator

Lowest quartile (Quartile 1) of fasting SHR, FPG, or HbA1c.

Outcome

In-hospital mortality (cardiac or non-cardiac death during hospitalization), adjudicated by blinded medical personnel.hard clinical

Main Result

Odds Ratio: 4.07 (95% CI 2.014–8.228)

Absolute Event Rate: 9.7% vs 2%

Limitations

Secondary analysis of a registry, making it impossible to control all confounding factors
Potential selection bias as only participants with FPG and HbA1c levels were included
Did not investigate the relationship between fasting SHR and in-hospital mortality in prediabetic patients exclusively
Did not compare the prognostic effect of fasting SHR and conventional SHR
Fasting SHR and FPG are derived from a single blood glucose test, which cannot reflect the full profile of glucose swings
Conclusions cannot be directly extrapolated to non-Asian populations without validation

Cite This Study

synapsesocial.com/papers/6a7f084deb525c734d9c41d2 https://doi.org/10.1186/s12933-023-01868-7

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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