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首页> 外文期刊>Circulation journal >Higher Hemoglobin A1c After Discharge Is an Independent Predictor of Adverse Outcomes in Patients With Acute Coronary Syndrome　– Findings From the PACIFIC Registry –
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Higher Hemoglobin A1c After Discharge Is an Independent Predictor of Adverse Outcomes in Patients With Acute Coronary Syndrome　– Findings From the PACIFIC Registry –

机译：出院后高血红蛋白A1c是急性冠脉综合征患者不良结局的独立预测因子– PACIFIC注册表中的发现–

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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 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)
机译：背景：最佳药物治疗（OMT）和冠状动脉危险因素的管理对于急性后冠状动脉综合征（ACS）患者的主要不良心脏和脑血管事件（MACCE）的二级预防是必要的。但是，尚未在日本患者中研究出院后患者依从性的影响。方法和结果：预防缺血性冠心病（PACIFIC）登记后的动脉粥样硬化事件是一项对3,597例ACS患者的多中心，前瞻性观察性研究。在住院至出院后一年之间的229例患者中发生死亡或MACCE。在2587例患者中，评估了1年时OMT的依从性和危险因素控制与出院后1年至2年之间发生的MACCE之间的关联。 OMT被定义为使用抗血小板药，血管紧张素转化酶抑制剂，β受体阻滞剂和他汀类药物。危险因素指标为：低密度脂蛋白胆固醇2 。 MACCE的发生率为1.8％，与女性相关（P = 0.020），年龄≥75岁（P = 0.004），HbA1c≥7.0％（P = 0.004），LV射血分数<35％（P <0.001），估计的肾小球滤过率<60 ml / min（P = 0.008）和脑梗塞病史（P = 0.003）。在多变量分析中，ACS后较低的出院后HbA1c与较低的MACCE风险密切相关（P = 0.004）。结论：出院后高血糖是预防ACS后MACCE的重要目标。 （Circ J 2016; 80：1607-1614）

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