Higher hemoglobin A1c after discharge is an independent predictor of adverse outcomes in patients with acute coronary syndrome-findings from the PACIFIC registry–

PACIFIC investigators

Research output: Contribution to journalArticle

Abstract

Background: Optimal medical therapy (OMT) and the management of coronary risk factors are necessary for secondary prevention of major adverse cardiac and cerebrovascular events (MACCE) in post-acute coronary syndrome (ACS) patients. However, the effect of post-discharge patient adherence has not been investigated in Japanese patients. Methods and Results: The Prevention of AtherothrombotiC Incidents Following Ischemic Coronary Attack (PACIFIC) registry was a multicenter, prospective observational study of 3,597 patients with ACS. Death or MACCE occurred in 229 patients between hospitalization and up to 1 year after discharge. Among 2,587 patients, the association between OMT adherence and risk factor control at 1 year and MACCE occurring between 1 and 2 years after discharge was assessed. OMT was defined as the use of antiplatelet agents, angiotensin-converting enzyme inhibitors, β-blockers, and statins. Risk factor targets were: low-density lipoprotein-cholesterol <100 mg/dl, HbA1c <7.0%, non-smoking status, blood pressure <130/80 mmHg, and 18.5≤body mass index ≤ 24.9 kg/m 2 . The incidence of MACCE was 1.8% and associated with female sex (P=0.020), age ≥75 years (P=0.004), HbA1c ≥7.0% (P=0.004), LV ejection fraction <35% (P<0.001), estimated glomerular filtration rate <60 ml/min (P=0.008), and history of cerebral infarction (P=0.003). In multivariate analysis, lower post-discharge HbA1c was strongly associated with a lower risk of MACCE after ACS (P=0.004). Conclusions: Hyperglycemia after discharge is a crucial target for the prevention of MACCE in post-ACS patients.

Original languageEnglish
Pages (from-to)1607-1614
Number of pages8
JournalCirculation Journal
Volume80
Issue number7
DOIs
Publication statusPublished - Jan 1 2016

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Acute Coronary Syndrome
Registries
Hemoglobins
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Platelet Aggregation Inhibitors
Cerebral Infarction
Patient Compliance
Secondary Prevention
Glomerular Filtration Rate
Angiotensin-Converting Enzyme Inhibitors
Hyperglycemia
LDL Cholesterol
Observational Studies
Hospitalization
Therapeutics
Multivariate Analysis
Prospective Studies
Blood Pressure
Incidence

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Higher hemoglobin A1c after discharge is an independent predictor of adverse outcomes in patients with acute coronary syndrome-findings from the PACIFIC registry–. / PACIFIC investigators.

In: Circulation Journal, Vol. 80, No. 7, 01.01.2016, p. 1607-1614.

Research output: Contribution to journalArticle

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abstract = "Background: Optimal medical therapy (OMT) and the management of coronary risk factors are necessary for secondary prevention of major adverse cardiac and cerebrovascular events (MACCE) in post-acute coronary syndrome (ACS) patients. However, the effect of post-discharge patient adherence has not been investigated in Japanese patients. Methods and Results: The Prevention of AtherothrombotiC Incidents Following Ischemic Coronary Attack (PACIFIC) registry was a multicenter, prospective observational study of 3,597 patients with ACS. Death or MACCE occurred in 229 patients between hospitalization and up to 1 year after discharge. Among 2,587 patients, the association between OMT adherence and risk factor control at 1 year and MACCE occurring between 1 and 2 years after discharge was assessed. OMT was defined as the use of antiplatelet agents, angiotensin-converting enzyme inhibitors, β-blockers, and statins. Risk factor targets were: low-density lipoprotein-cholesterol <100 mg/dl, HbA1c <7.0{\%}, non-smoking status, blood pressure <130/80 mmHg, and 18.5≤body mass index ≤ 24.9 kg/m 2 . The incidence of MACCE was 1.8{\%} and associated with female sex (P=0.020), age ≥75 years (P=0.004), HbA1c ≥7.0{\%} (P=0.004), LV ejection fraction <35{\%} (P<0.001), estimated glomerular filtration rate <60 ml/min (P=0.008), and history of cerebral infarction (P=0.003). In multivariate analysis, lower post-discharge HbA1c was strongly associated with a lower risk of MACCE after ACS (P=0.004). Conclusions: Hyperglycemia after discharge is a crucial target for the prevention of MACCE in post-ACS patients.",
author = "{PACIFIC investigators} and Keiji Noguchi and Mamoru Sakakibara and Naoya Asakawa and Yusuke Tokuda and Kiwamu Kamiya and Takashi Yoshitani and Koji Oba and Katsumi Miyauchi and Yuji Nishizaki and Hisao Ogawa and Hiroyoshi Yokoi and Masayasu Matsumoto and Masafumi Kitakaze and Takeshi Kimura and Tetsuo Matsubara and Yuji Ikari and Kazuo Kimura and Hideki Origasa and Takaaki Isshiki and Yoshihiro Morino and Hiroyuki Daida and Hiroyuki Tsutsui",
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AU - PACIFIC investigators

AU - Noguchi, Keiji

AU - Sakakibara, Mamoru

AU - Asakawa, Naoya

AU - Tokuda, Yusuke

AU - Kamiya, Kiwamu

AU - Yoshitani, Takashi

AU - Oba, Koji

AU - Miyauchi, Katsumi

AU - Nishizaki, Yuji

AU - Ogawa, Hisao

AU - Yokoi, Hiroyoshi

AU - Matsumoto, Masayasu

AU - Kitakaze, Masafumi

AU - Kimura, Takeshi

AU - Matsubara, Tetsuo

AU - Ikari, Yuji

AU - Kimura, Kazuo

AU - Origasa, Hideki

AU - Isshiki, Takaaki

AU - Morino, Yoshihiro

AU - Daida, Hiroyuki

AU - Tsutsui, Hiroyuki

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Background: Optimal medical therapy (OMT) and the management of coronary risk factors are necessary for secondary prevention of major adverse cardiac and cerebrovascular events (MACCE) in post-acute coronary syndrome (ACS) patients. However, the effect of post-discharge patient adherence has not been investigated in Japanese patients. Methods and Results: The Prevention of AtherothrombotiC Incidents Following Ischemic Coronary Attack (PACIFIC) registry was a multicenter, prospective observational study of 3,597 patients with ACS. Death or MACCE occurred in 229 patients between hospitalization and up to 1 year after discharge. Among 2,587 patients, the association between OMT adherence and risk factor control at 1 year and MACCE occurring between 1 and 2 years after discharge was assessed. OMT was defined as the use of antiplatelet agents, angiotensin-converting enzyme inhibitors, β-blockers, and statins. Risk factor targets were: low-density lipoprotein-cholesterol <100 mg/dl, HbA1c <7.0%, non-smoking status, blood pressure <130/80 mmHg, and 18.5≤body mass index ≤ 24.9 kg/m 2 . The incidence of MACCE was 1.8% and associated with female sex (P=0.020), age ≥75 years (P=0.004), HbA1c ≥7.0% (P=0.004), LV ejection fraction <35% (P<0.001), estimated glomerular filtration rate <60 ml/min (P=0.008), and history of cerebral infarction (P=0.003). In multivariate analysis, lower post-discharge HbA1c was strongly associated with a lower risk of MACCE after ACS (P=0.004). Conclusions: Hyperglycemia after discharge is a crucial target for the prevention of MACCE in post-ACS patients.

AB - Background: Optimal medical therapy (OMT) and the management of coronary risk factors are necessary for secondary prevention of major adverse cardiac and cerebrovascular events (MACCE) in post-acute coronary syndrome (ACS) patients. However, the effect of post-discharge patient adherence has not been investigated in Japanese patients. Methods and Results: The Prevention of AtherothrombotiC Incidents Following Ischemic Coronary Attack (PACIFIC) registry was a multicenter, prospective observational study of 3,597 patients with ACS. Death or MACCE occurred in 229 patients between hospitalization and up to 1 year after discharge. Among 2,587 patients, the association between OMT adherence and risk factor control at 1 year and MACCE occurring between 1 and 2 years after discharge was assessed. OMT was defined as the use of antiplatelet agents, angiotensin-converting enzyme inhibitors, β-blockers, and statins. Risk factor targets were: low-density lipoprotein-cholesterol <100 mg/dl, HbA1c <7.0%, non-smoking status, blood pressure <130/80 mmHg, and 18.5≤body mass index ≤ 24.9 kg/m 2 . The incidence of MACCE was 1.8% and associated with female sex (P=0.020), age ≥75 years (P=0.004), HbA1c ≥7.0% (P=0.004), LV ejection fraction <35% (P<0.001), estimated glomerular filtration rate <60 ml/min (P=0.008), and history of cerebral infarction (P=0.003). In multivariate analysis, lower post-discharge HbA1c was strongly associated with a lower risk of MACCE after ACS (P=0.004). Conclusions: Hyperglycemia after discharge is a crucial target for the prevention of MACCE in post-ACS patients.

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JF - Circulation Journal

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