title: Higher Hemoglobin A1c After Discharge Is an Independent Predictor of Adverse Outcomes in Patients With Acute Coronary Syndrome　- Findings From the PACIFIC Registry.
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.
  
  
  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. (Circ J 2016; 80: 1607-1614).
authors.affiliation: Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine.
authors.forename: Keiji
authors.initials: K
authors.lastname: Noguchi
authors.forename: Mamoru
authors.initials: M
authors.lastname: Sakakibara
authors.forename: Naoya
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authors.lastname: Asakawa
authors.forename: Yusuke
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authors.lastname: Tokuda
authors.forename: Kiwamu
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authors.lastname: Kamiya
authors.forename: Takashi
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authors.lastname: Yoshitani
authors.forename: Koji
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authors.lastname: Oba
authors.forename: Katsumi
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authors.lastname: Miyauchi
authors.forename: Yuji
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authors.lastname: Nishizaki
authors.forename: Hisao
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authors.lastname: Ogawa
authors.forename: Hiroyoshi
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authors.lastname: Yokoi
authors.forename: Masayasu
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authors.lastname: Matsumoto
authors.forename: Masafumi
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authors.lastname: Kitakaze
authors.forename: Takeshi
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authors.lastname: Kimura
authors.forename: Tetsuo
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authors.lastname: Matsubara
authors.forename: Yuji
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authors.lastname: Ikari
authors.forename: Kazuo
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authors.lastname: Kimura
authors.forename: Hideki
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authors.lastname: Origasa
authors.forename: Takaaki
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authors.lastname: Isshiki
authors.forename: Yoshihiro
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authors.lastname: Morino
authors.forename: Hiroyuki
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authors.lastname: Daida
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsutsui
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000401:mortality / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D008078:Cholesterol, LDL / Q000097:blood; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human