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Predictors of 1-year outcomes in the Taiwan Acute Coronary Syndrome Full Spectrum Registry.
J Formos Med Assoc. 2014 Nov; 113(11):794-802.JF

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.

Authors+Show Affiliations

National Taiwan University Hospital, Taipei, Taiwan. Electronic address: futienc@ntuh.gov.tw.Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan. Electronic address: shyukg@ms12.hinet.net.Chang Gung University College of Medicine, Taoyuan, Taiwan; Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.Mackay Memorial Hospital and Mackay Medicine, Nursing and Management College, Taipei, Taiwan.Far Eastern Memorial Hospital, Taipei, Taiwan.Chang Gung University College of Medicine, Taoyuan, Taiwan; Linkou Chang Gung Memorial Hospital, Linkou, Taiwan.Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan.Taipei Veterans General Hospital, Taipei, Taiwan.Chang Gung University College of Medicine, Taoyuan, Taiwan; Linkou Chang Gung Memorial Hospital, Linkou, Taiwan.Sin Lau Christian Hospital, Tainan, Taiwan.National Cheng Kung University College of Medicine, Tainan, Taiwan; National Cheng Kung University Hospital, Tainan, Taiwan.National Taiwan University Hospital, Taipei, Taiwan. Electronic address: jueyhwang@ntu.edu.tw.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24076272

Citation

Chiang, Fu-Tien, et al. "Predictors of 1-year Outcomes in the Taiwan Acute Coronary Syndrome Full Spectrum Registry." Journal of the Formosan Medical Association = Taiwan Yi Zhi, vol. 113, no. 11, 2014, pp. 794-802.
Chiang FT, Shyu KG, Wu CJ, et al. Predictors of 1-year outcomes in the Taiwan Acute Coronary Syndrome Full Spectrum Registry. J Formos Med Assoc. 2014;113(11):794-802.
Chiang, F. T., Shyu, K. G., Wu, C. J., Mar, G. Y., Hou, C. J., Li, A. H., Wen, M. S., Lai, W. T., Lin, S. J., Kuo, C. T., Kuo, C., Li, Y. H., & Hwang, J. J. (2014). Predictors of 1-year outcomes in the Taiwan Acute Coronary Syndrome Full Spectrum Registry. Journal of the Formosan Medical Association = Taiwan Yi Zhi, 113(11), 794-802. https://doi.org/10.1016/j.jfma.2013.08.001
Chiang FT, et al. Predictors of 1-year Outcomes in the Taiwan Acute Coronary Syndrome Full Spectrum Registry. J Formos Med Assoc. 2014;113(11):794-802. PubMed PMID: 24076272.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of 1-year outcomes in the Taiwan Acute Coronary Syndrome Full Spectrum Registry. AU - Chiang,Fu-Tien, AU - Shyu,Kou-Gi, AU - Wu,Chiung-Jen, AU - Mar,Guang-Yuan, AU - Hou,Charles Jia-Yin, AU - Li,Ai-Hsien, AU - Wen,Ming-Shien, AU - Lai,Wen-Ter, AU - Lin,Shing-Jong, AU - Kuo,Chi-Tai, AU - Kuo,Chieh, AU - Li,Yi-Heng, AU - Hwang,Juey-Jen, AU - ,, Y1 - 2013/09/26/ PY - 2012/12/12/received PY - 2013/08/05/revised PY - 2013/08/08/accepted PY - 2013/10/1/entrez PY - 2013/10/1/pubmed PY - 2015/10/31/medline KW - Taiwan KW - acute coronary syndrome KW - antiplatelet agents KW - clopidogrel KW - survival rates SP - 794 EP - 802 JF - Journal of the Formosan Medical Association = Taiwan yi zhi JO - J Formos Med Assoc VL - 113 IS - 11 N2 - 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. SN - 0929-6646 UR - https://www.unboundmedicine.com/medline/citation/24076272/Predictors_of_1_year_outcomes_in_the_Taiwan_Acute_Coronary_Syndrome_Full_Spectrum_Registry_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0929-6646(13)00268-4 DB - PRIME DP - Unbound Medicine ER -