Predictors of 1-year outcomes in the Taiwan Acute Coronary Syndrome Full Spectrum Registry.
OBJECTIVE
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.


CONCLUSIONS
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.
National Taiwan University Hospital, Taipei, Taiwan. Electronic address: futienc@ntuh.gov.tw.
Fu-Tien
FT
Chiang
Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan. Electronic address: shyukg@ms12.hinet.net.
Kou-Gi
KG
Shyu
Chang Gung University College of Medicine, Taoyuan, Taiwan; Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Chiung-Jen
CJ
Wu
Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Guang-Yuan
GY
Mar
Mackay Memorial Hospital and Mackay Medicine, Nursing and Management College, Taipei, Taiwan.
Charles Jia-Yin
CJ
Hou
Far Eastern Memorial Hospital, Taipei, Taiwan.
Ai-Hsien
AH
Li
Chang Gung University College of Medicine, Taoyuan, Taiwan; Linkou Chang Gung Memorial Hospital, Linkou, Taiwan.
Ming-Shien
MS
Wen
Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan.
Wen-Ter
WT
Lai
Taipei Veterans General Hospital, Taipei, Taiwan.
Shing-Jong
SJ
Lin
Chang Gung University College of Medicine, Taoyuan, Taiwan; Linkou Chang Gung Memorial Hospital, Linkou, Taiwan.
Chi-Tai
CT
Kuo
Sin Lau Christian Hospital, Tainan, Taiwan.
Chieh
C
Kuo
National Cheng Kung University College of Medicine, Tainan, Taiwan; National Cheng Kung University Hospital, Tainan, Taiwan.
Yi-Heng
YH
Li
National Taiwan University Hospital, Taipei, Taiwan. Electronic address: jueyhwang@ntu.edu.tw.
Juey-Jen
JJ
Hwang
D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D000368:Aged; D001241:Aspirin / Q000627:therapeutic use*; D000077144:Clopidogrel; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D010351:Patient Discharge; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011379:Prognosis; D012042:Registries; D020521:Stroke / Q000453:epidemiology*; D013624:Taiwan; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
Taiwan; acute coronary syndrome; antiplatelet agents; clopidogrel; survival rates