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

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)211-223
Number of pages13
JournalActa Cardiologica Sinica
Volume34
Issue number3
DOIs
Publication statusPublished - 2018 May

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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