https://scholars.lib.ntu.edu.tw/handle/123456789/553687
標題: | 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 | 作者: | Chen K.-C. Yin W.-H. CHIH-CHENG WU Chan S.-H. YEN-WEN WU Wang K.Y. Chang K.-C. HWANG, JUEY-JEN Voon W.-C. Hsieh I.-C. Chong J.-T. Lin W.-S. Hsu C.-N. Ueng K.-C. Hsia C.-P. Liu J.-C. Yeh J.-S. Mar G.-Y. Shih J.-Y. Kuo J.-Y. Tsao H.-M. Tseng W.-K. Yang C.-H. Chang C.-C. Chiang C.-E. Lei M.-H. Lin J.-F. Shyu K.-G. |
公開日期: | 2018 | 卷: | 34 | 期: | 3 | 起(迄)頁: | 211-223 | 來源出版物: | Acta Cardiologica Sinica | 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. ? 2018, Republic of China Society of Cardiology. All rights reserved. |
URI: | https://scholars.lib.ntu.edu.tw/handle/123456789/553687 | ISSN: | 1011-6842 | DOI: | 10.6515/ACS.201805_34(3).20180207B | SDG/關鍵字: | acetylsalicylic acid; beta adrenergic receptor blocking agent; dipeptidyl peptidase IV inhibitor; glitazone derivative; hemoglobin A1c; hydroxymethylglutaryl coenzyme A reductase inhibitor; meglitinide; metformin; oral antidiabetic agent; sulfonylurea; acute coronary syndrome; acute kidney failure; adult; aged; Article; atrial fibrillation; blood clot lysis; cardiogenic shock; diabetes mellitus; dual antiplatelet therapy; dyslipidemia; evidence based medicine; female; fibrinolysis; fibrinolytic therapy; glycemic control; heart failure; heart infarction; heart ventricle arrhythmia; hospital mortality; human; hypertension; major clinical study; male; mortality rate; non ST segment elevation myocardial infarction; observational study; percutaneous coronary intervention; peripheral occlusive artery disease; reperfusion; risk factor; smoking; unstable angina pectoris |
顯示於: | 醫學院附設醫院 (臺大醫院) |
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