Higher Hemoglobin A1c After Discharge Is an Independent Predictor of Adverse Outcomes in Patients With Acute Coronary Syndrome　– Findings From the PACIFIC Registry –

Keiji Noguchi; Mamoru Sakakibara; Naoya Asakawa; Yusuke Tokuda; Kiwamu Kamiya; Takashi Yoshitani; Koji Oba; Katsumi Miyauchi; Yuji Nishizaki; Hisao Ogawa; Hiroyoshi Yokoi; Masayasu Matsumoto; Masafumi Kitakaze; Takeshi Kimura; Tetsuo Matsubara; Yuji Ikari; Kazuo Kimura; Hideki Origasa; Takaaki Isshiki; Yoshihiro Morino; Hiroyuki Daida; Hiroyuki Tsutsui; on behalf of the PACIFIC investigators

doi:10.1253/circj.CJ-15-1126

Ischemic Heart Disease

Higher Hemoglobin A1c After Discharge Is an Independent Predictor of Adverse Outcomes in Patients With Acute Coronary Syndrome　– Findings From the PACIFIC Registry –

Keiji Noguchi, Mamoru Sakakibara, Naoya Asakawa, Yusuke Tokuda, Kiwamu Kamiya, Takashi Yoshitani, Koji Oba, Katsumi Miyauchi, Yuji Nishizaki, Hisao Ogawa, Hiroyoshi Yokoi, Masayasu Matsumoto, Masafumi Kitakaze, Takeshi Kimura, Tetsuo Matsubara, Yuji Ikari, Kazuo Kimura, Hideki Origasa, Takaaki Isshiki, Yoshihiro Morino, Hiroyuki Daida, Hiroyuki Tsutsui, on behalf of the PACIFIC investigators

Author information

Keiji Noguchi
Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
Mamoru Sakakibara
Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
Naoya Asakawa
Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
Yusuke Tokuda
Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
Kiwamu Kamiya
Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
Takashi Yoshitani
Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
Koji Oba
Department of Biostatistics, School of Public Health, Graduate School of Medicine, The University of Tokyo
Katsumi Miyauchi
Department of Cardiovascular Medicine, Juntendo University School of Medicine
Yuji Nishizaki
Department of Cardiovascular Medicine, Juntendo University School of Medicine
Hisao Ogawa
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
National Cerebral and Cardiovascular Center
Hiroyoshi Yokoi
Department of Cardiology, Fukuoka Sanno Hospital
Masayasu Matsumoto
Department of Clinical Neuroscience and Therapeutics Division of Integrated Medical Science, Graduate School of Biomedical Sciences, Hiroshima University
Masafumi Kitakaze
Cardiovascular Division, National Cerebral and Cardiovascular Center
Takeshi Kimura
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
Tetsuo Matsubara
Toyohashi Heart Center
Yuji Ikari
Department of Cardiology, Tokai University School of Medicine
Kazuo Kimura
Division of Cardiology, Yokohama City University Medical Center
Hideki Origasa
Division of Biostatistics and Clinical Epidemiology, School of Medicine and Pharmaceutical Sciences, University of Toyama
Takaaki Isshiki
Division of Cardiology, Department of Internal Medicine, Teikyo University School of Medicine
Yoshihiro Morino
Department of Internal Medicine, Iwate Medical University
Hiroyuki Daida
Department of Cardiovascular Medicine, Juntendo University School of Medicine
Hiroyuki Tsutsui
Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
on behalf of the PACIFIC investigators

Keywords: Acute coronary syndrome, HbA1c, Major adverse cardiac and cerebrovascular events, Secondary prevention

JOURNAL FREE ACCESS FULL-TEXT HTML

2016 Volume 80 Issue 7 Pages 1607-1614

DOI https://doi.org/10.1253/circj.CJ-15-1126

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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/m². 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)

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