In-hospital implementation of evidence-based, medications is associated with improved survival, in diabetic patients with acute coronary, syndrome - Data from TSOC ACS-DM registry

Kuan Chun Chen, Wei Hsian Yin, Chih Cheng Wu, Shih Hung Chan, Yen Wen Wu, Kuo Yang Wang, Kuan Cheng Chang, Juey Jen Hwang, Wen Chol Voon, I. Chang Hsieh, Jun Ted Chong, Wei Shiang Lin, Chih Neng Hsu, Kwo Chang Ueng, Chih Ping Hsia, Ju Chi Liu, Jong Shiuan Yeh, Guang Yuan Mar, Jhih Yuan Shih, Jen Yuan KuoHsuan Ming Tsao, Wei Kung Tseng, Cheng Hsu Yang, Chao Chien Chang, Chern En Chiang, Meng Heng Lei, Jeng Feng Lin, Kou Gi Shyu

研究成果: 雜誌貢獻文章

9 引文 (Scopus)

摘要

Background: Patients with acute coronary syndrome (ACS) and diabetes mellitus (DM) receive less aggressive treatment and have worse outcomes in Taiwan. We sought to explore whether the current practices of prescribing guideline-directed medical therapy (GDMT) for ACS and clinical outcomes have improved over time. Methods: A total of 1534 consecutive diabetic patients with ACS were enrolled between 2013 and 2015 from 27 hospitals in the nationwide registry initiated by the Taiwan Society of Cardiology (the TSOC ACS-DM Registry). Baseline and clinical demographics, treatment, and clinical outcomes were compared to those of 1000 ACS patients with DMrecruited in the Taiwan ACS-full spectrum (ACS-FS) Registry, whichwas performed between 2008 and 2010. Results: Compared to the DMpatients in the Taiwan ACS-FS Registry, even though reperfusion therapy was carried out in significantly fewer patients, the primary percutaneous coronary intervention (PCI) rate for ST-segment elevation myocardial infarction (STEMI) and the prescription rates of GDMT for ACS including P2Y12 inhibitors, renin-angiotensin blockers, beta-blockers, and statins were significantly higher in those in the TSOC ACS-DM Registry. Moreover, significant reductions in 1-year mortality, recurrent nonfatal MI and stroke were observed compared to those of the DM patients in the Taiwan ACS-FS Registry. Multivariate analysis identified reperfusion therapy in combination with GDMT as a strong predictor of better 1-year outcomes [hazard ratio (95% confidence interval) = 0.54 (0.33-0.89)]. Conclusions: Marked improvements in performing primary PCI for STEMI and prescribing GDMT for ACS were observed over time in Taiwan. This was associated with improved 1-year event-free survival in the diabetic patients with ACS.
原文英語
頁(從 - 到)211-223
頁數13
期刊Acta Cardiologica Sinica
34
發行號3
DOIs
出版狀態已發佈 - 五月 1 2018

指紋

Acute Coronary Syndrome
Registries
Diabetes Mellitus
Survival
Taiwan
Guidelines
Percutaneous Coronary Intervention
Therapeutics
Reperfusion
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Angiotensins
Cardiology
Practice Guidelines
Renin
Disease-Free Survival
Prescriptions
Multivariate Analysis
Stroke
Demography
Confidence Intervals

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

引用此文

In-hospital implementation of evidence-based, medications is associated with improved survival, in diabetic patients with acute coronary, syndrome - Data from TSOC ACS-DM registry. / Chen, Kuan Chun; Yin, Wei Hsian; Wu, Chih Cheng; Chan, Shih Hung; Wu, Yen Wen; Wang, Kuo Yang; Chang, Kuan Cheng; Hwang, Juey Jen; Voon, Wen Chol; Hsieh, I. Chang; Chong, Jun Ted; Lin, Wei Shiang; Hsu, Chih Neng; Ueng, Kwo Chang; Hsia, Chih Ping; Liu, Ju Chi; Yeh, Jong Shiuan; Mar, Guang Yuan; Shih, Jhih Yuan; Kuo, Jen Yuan; Tsao, Hsuan Ming; Tseng, Wei Kung; Yang, Cheng Hsu; Chang, Chao Chien; Chiang, Chern En; Lei, Meng Heng; Lin, Jeng Feng; Shyu, Kou Gi.

於: Acta Cardiologica Sinica, 卷 34, 編號 3, 01.05.2018, p. 211-223.

研究成果: 雜誌貢獻文章

Chen, KC, Yin, WH, Wu, CC, Chan, SH, Wu, YW, Wang, KY, Chang, KC, Hwang, JJ, Voon, WC, Hsieh, IC, Chong, JT, Lin, WS, Hsu, CN, Ueng, KC, Hsia, CP, Liu, JC, Yeh, JS, Mar, GY, Shih, JY, Kuo, JY, Tsao, HM, Tseng, WK, Yang, CH, Chang, CC, Chiang, CE, Lei, MH, Lin, JF & Shyu, KG 2018, 'In-hospital implementation of evidence-based, medications is associated with improved survival, in diabetic patients with acute coronary, syndrome - Data from TSOC ACS-DM registry', Acta Cardiologica Sinica, 卷 34, 編號 3, 頁 211-223. https://doi.org/10.6515/ACS.201805_34(3).20180207B
Chen, Kuan Chun ; Yin, Wei Hsian ; Wu, Chih Cheng ; Chan, Shih Hung ; Wu, Yen Wen ; Wang, Kuo Yang ; Chang, Kuan Cheng ; Hwang, Juey Jen ; Voon, Wen Chol ; Hsieh, I. Chang ; Chong, Jun Ted ; Lin, Wei Shiang ; Hsu, Chih Neng ; Ueng, Kwo Chang ; Hsia, Chih Ping ; Liu, Ju Chi ; Yeh, Jong Shiuan ; Mar, Guang Yuan ; Shih, Jhih Yuan ; Kuo, Jen Yuan ; Tsao, Hsuan Ming ; Tseng, Wei Kung ; Yang, Cheng Hsu ; Chang, Chao Chien ; Chiang, Chern En ; Lei, Meng Heng ; Lin, Jeng Feng ; Shyu, Kou Gi. / In-hospital implementation of evidence-based, medications is associated with improved survival, in diabetic patients with acute coronary, syndrome - Data from TSOC ACS-DM registry. 於: Acta Cardiologica Sinica. 2018 ; 卷 34, 編號 3. 頁 211-223.
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abstract = "Background: Patients with acute coronary syndrome (ACS) and diabetes mellitus (DM) receive less aggressive treatment and have worse outcomes in Taiwan. We sought to explore whether the current practices of prescribing guideline-directed medical therapy (GDMT) for ACS and clinical outcomes have improved over time. Methods: A total of 1534 consecutive diabetic patients with ACS were enrolled between 2013 and 2015 from 27 hospitals in the nationwide registry initiated by the Taiwan Society of Cardiology (the TSOC ACS-DM Registry). Baseline and clinical demographics, treatment, and clinical outcomes were compared to those of 1000 ACS patients with DMrecruited in the Taiwan ACS-full spectrum (ACS-FS) Registry, whichwas performed between 2008 and 2010. Results: Compared to the DMpatients in the Taiwan ACS-FS Registry, even though reperfusion therapy was carried out in significantly fewer patients, the primary percutaneous coronary intervention (PCI) rate for ST-segment elevation myocardial infarction (STEMI) and the prescription rates of GDMT for ACS including P2Y12 inhibitors, renin-angiotensin blockers, beta-blockers, and statins were significantly higher in those in the TSOC ACS-DM Registry. Moreover, significant reductions in 1-year mortality, recurrent nonfatal MI and stroke were observed compared to those of the DM patients in the Taiwan ACS-FS Registry. Multivariate analysis identified reperfusion therapy in combination with GDMT as a strong predictor of better 1-year outcomes [hazard ratio (95{\%} confidence interval) = 0.54 (0.33-0.89)]. Conclusions: Marked improvements in performing primary PCI for STEMI and prescribing GDMT for ACS were observed over time in Taiwan. This was associated with improved 1-year event-free survival in the diabetic patients with ACS.",
keywords = "Acute coronary syndrome, Guideline-directed medical therapy, Oral anti-diabetic drug, Outcome, Type 2 diabetes",
author = "Chen, {Kuan Chun} and Yin, {Wei Hsian} and Wu, {Chih Cheng} and Chan, {Shih Hung} and Wu, {Yen Wen} and Wang, {Kuo Yang} and Chang, {Kuan Cheng} and Hwang, {Juey Jen} and Voon, {Wen Chol} and Hsieh, {I. Chang} and Chong, {Jun Ted} and Lin, {Wei Shiang} and Hsu, {Chih Neng} and Ueng, {Kwo Chang} and Hsia, {Chih Ping} and Liu, {Ju Chi} and Yeh, {Jong Shiuan} and Mar, {Guang Yuan} and Shih, {Jhih Yuan} and Kuo, {Jen Yuan} and Tsao, {Hsuan Ming} and Tseng, {Wei Kung} and Yang, {Cheng Hsu} and Chang, {Chao Chien} and Chiang, {Chern En} and Lei, {Meng Heng} and Lin, {Jeng Feng} and Shyu, {Kou Gi}",
year = "2018",
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language = "English",
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pages = "211--223",
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TY - JOUR

T1 - In-hospital implementation of evidence-based, medications is associated with improved survival, in diabetic patients with acute coronary, syndrome - Data from TSOC ACS-DM registry

AU - Chen, Kuan Chun

AU - Yin, Wei Hsian

AU - Wu, Chih Cheng

AU - Chan, Shih Hung

AU - Wu, Yen Wen

AU - Wang, Kuo Yang

AU - Chang, Kuan Cheng

AU - Hwang, Juey Jen

AU - Voon, Wen Chol

AU - Hsieh, I. Chang

AU - Chong, Jun Ted

AU - Lin, Wei Shiang

AU - Hsu, Chih Neng

AU - Ueng, Kwo Chang

AU - Hsia, Chih Ping

AU - Liu, Ju Chi

AU - Yeh, Jong Shiuan

AU - Mar, Guang Yuan

AU - Shih, Jhih Yuan

AU - Kuo, Jen Yuan

AU - Tsao, Hsuan Ming

AU - Tseng, Wei Kung

AU - Yang, Cheng Hsu

AU - Chang, Chao Chien

AU - Chiang, Chern En

AU - Lei, Meng Heng

AU - Lin, Jeng Feng

AU - Shyu, Kou Gi

PY - 2018/5/1

Y1 - 2018/5/1

N2 - Background: Patients with acute coronary syndrome (ACS) and diabetes mellitus (DM) receive less aggressive treatment and have worse outcomes in Taiwan. We sought to explore whether the current practices of prescribing guideline-directed medical therapy (GDMT) for ACS and clinical outcomes have improved over time. Methods: A total of 1534 consecutive diabetic patients with ACS were enrolled between 2013 and 2015 from 27 hospitals in the nationwide registry initiated by the Taiwan Society of Cardiology (the TSOC ACS-DM Registry). Baseline and clinical demographics, treatment, and clinical outcomes were compared to those of 1000 ACS patients with DMrecruited in the Taiwan ACS-full spectrum (ACS-FS) Registry, whichwas performed between 2008 and 2010. Results: Compared to the DMpatients in the Taiwan ACS-FS Registry, even though reperfusion therapy was carried out in significantly fewer patients, the primary percutaneous coronary intervention (PCI) rate for ST-segment elevation myocardial infarction (STEMI) and the prescription rates of GDMT for ACS including P2Y12 inhibitors, renin-angiotensin blockers, beta-blockers, and statins were significantly higher in those in the TSOC ACS-DM Registry. Moreover, significant reductions in 1-year mortality, recurrent nonfatal MI and stroke were observed compared to those of the DM patients in the Taiwan ACS-FS Registry. Multivariate analysis identified reperfusion therapy in combination with GDMT as a strong predictor of better 1-year outcomes [hazard ratio (95% confidence interval) = 0.54 (0.33-0.89)]. Conclusions: Marked improvements in performing primary PCI for STEMI and prescribing GDMT for ACS were observed over time in Taiwan. This was associated with improved 1-year event-free survival in the diabetic patients with ACS.

AB - Background: Patients with acute coronary syndrome (ACS) and diabetes mellitus (DM) receive less aggressive treatment and have worse outcomes in Taiwan. We sought to explore whether the current practices of prescribing guideline-directed medical therapy (GDMT) for ACS and clinical outcomes have improved over time. Methods: A total of 1534 consecutive diabetic patients with ACS were enrolled between 2013 and 2015 from 27 hospitals in the nationwide registry initiated by the Taiwan Society of Cardiology (the TSOC ACS-DM Registry). Baseline and clinical demographics, treatment, and clinical outcomes were compared to those of 1000 ACS patients with DMrecruited in the Taiwan ACS-full spectrum (ACS-FS) Registry, whichwas performed between 2008 and 2010. Results: Compared to the DMpatients in the Taiwan ACS-FS Registry, even though reperfusion therapy was carried out in significantly fewer patients, the primary percutaneous coronary intervention (PCI) rate for ST-segment elevation myocardial infarction (STEMI) and the prescription rates of GDMT for ACS including P2Y12 inhibitors, renin-angiotensin blockers, beta-blockers, and statins were significantly higher in those in the TSOC ACS-DM Registry. Moreover, significant reductions in 1-year mortality, recurrent nonfatal MI and stroke were observed compared to those of the DM patients in the Taiwan ACS-FS Registry. Multivariate analysis identified reperfusion therapy in combination with GDMT as a strong predictor of better 1-year outcomes [hazard ratio (95% confidence interval) = 0.54 (0.33-0.89)]. Conclusions: Marked improvements in performing primary PCI for STEMI and prescribing GDMT for ACS were observed over time in Taiwan. This was associated with improved 1-year event-free survival in the diabetic patients with ACS.

KW - Acute coronary syndrome

KW - Guideline-directed medical therapy

KW - Oral anti-diabetic drug

KW - Outcome

KW - Type 2 diabetes

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U2 - 10.6515/ACS.201805_34(3).20180207B

DO - 10.6515/ACS.201805_34(3).20180207B

M3 - Article

AN - SCOPUS:85047087359

VL - 34

SP - 211

EP - 223

JO - Acta Cardiologica Sinica

JF - Acta Cardiologica Sinica

SN - 1011-6842

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