Fu-Tien Chiang1, Kou-Gi Shyu2, Chiung-Jen Wu3, Guang-Yuan Mar4, Charles Jia-Yin Hou5, Ai-Hsien Li6, Ming-Shien Wen7, Wen-Ter Lai8, Shing-Jong Lin9, Chi-Tai Kuo7, Chieh Kuo10, Yi-Heng Li11, Juey-Jen Hwang12. 1. National Taiwan University Hospital, Taipei, Taiwan. Electronic address: futienc@ntuh.gov.tw. 2. Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan. Electronic address: shyukg@ms12.hinet.net. 3. Chang Gung University College of Medicine, Taoyuan, Taiwan; Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. 4. Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. 5. Mackay Memorial Hospital and Mackay Medicine, Nursing and Management College, Taipei, Taiwan. 6. Far Eastern Memorial Hospital, Taipei, Taiwan. 7. Chang Gung University College of Medicine, Taoyuan, Taiwan; Linkou Chang Gung Memorial Hospital, Linkou, Taiwan. 8. Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan. 9. Taipei Veterans General Hospital, Taipei, Taiwan. 10. Sin Lau Christian Hospital, Tainan, Taiwan. 11. National Cheng Kung University College of Medicine, Tainan, Taiwan; National Cheng Kung University Hospital, Tainan, Taiwan. 12. National Taiwan University Hospital, Taipei, Taiwan. Electronic address: jueyhwang@ntu.edu.tw.
Abstract
BACKGROUND/ PURPOSE: Evidence-based guidelines have been formulated for optimal management of acute coronary syndrome (ACS). The Taiwan ACS Full Spectrum Registry aimed to evaluate the ACS management and identify the predictors of clinical outcomes of death/myocardial infarction/stroke 1 year post hospital discharge. METHODS: Three thousand and eighty confirmed ACS patients enrolled in this registry were followed up for 1 year at 3-month intervals. Patient data on medical interventions as well as clinical events were recorded and analyzed by descriptive statistics. RESULTS: One-year mortality among patients with ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and unstable angina was 6.1%, 10.1%, and 6.2%, respectively. Use of secondary preventive therapies was suboptimal throughout the follow-up phase, especially dual antiplatelet therapy, which fell from 74.8% patients at discharge to 24.9% patients at 1-year follow-up. The odds of an adverse incidence of death/myocardial infarction/stroke 1 year after discharge was significantly reduced in patients receiving aspirin and clopidogrel for ≥9 months and was consequently higher in patients in whom dual antiplatelet therapy was discontinued or prescribed for <9 months. Chronic renal failure, in-hospital bleeding, a diagnosis of NSTEMI, and antiplatelet therapy discontinuation had a negative association with 1-year outcomes, whereas the use of drug-eluting stents and antiplatelet agents, clopidogrel and aspirin, were predictors of positive outcomes. CONCLUSION: There is a significant deviation from evidence-based guidelines in ACS management in Taiwan as reported in other countries. Policy adherence, especially with regard to dual antiplatelet therapy may hold the key to long-term favorable outcomes and improved survival rates in ACS patients in Taiwan.
BACKGROUND/ PURPOSE: Evidence-based guidelines have been formulated for optimal management of acute coronary syndrome (ACS). The Taiwan ACS Full Spectrum Registry aimed to evaluate the ACS management and identify the predictors of clinical outcomes of death/myocardial infarction/stroke 1 year post hospital discharge. METHODS: Three thousand and eighty confirmed ACS patients enrolled in this registry were followed up for 1 year at 3-month intervals. Patient data on medical interventions as well as clinical events were recorded and analyzed by descriptive statistics. RESULTS: One-year mortality among patients with ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and unstable angina was 6.1%, 10.1%, and 6.2%, respectively. Use of secondary preventive therapies was suboptimal throughout the follow-up phase, especially dual antiplatelet therapy, which fell from 74.8% patients at discharge to 24.9% patients at 1-year follow-up. The odds of an adverse incidence of death/myocardial infarction/stroke 1 year after discharge was significantly reduced in patients receiving aspirin and clopidogrel for ≥9 months and was consequently higher in patients in whom dual antiplatelet therapy was discontinued or prescribed for <9 months. Chronic renal failure, in-hospital bleeding, a diagnosis of NSTEMI, and antiplatelet therapy discontinuation had a negative association with 1-year outcomes, whereas the use of drug-eluting stents and antiplatelet agents, clopidogrel and aspirin, were predictors of positive outcomes. CONCLUSION: There is a significant deviation from evidence-based guidelines in ACS management in Taiwan as reported in other countries. Policy adherence, especially with regard to dual antiplatelet therapy may hold the key to long-term favorable outcomes and improved survival rates in ACS patients in Taiwan.