Clinical Characteristics, Management and In-Hospital Outcomes of Patients with Acute Coronary Syndrome - Observations from the Taiwan ACS Full Spectrum Registry

Background: Acute coronary syndrome (ACS), largely manifested as ST-segment elevation myocardial infarction (STEMI), non-STEMI and unstable angina (UA), is a life-threatening disease. ACS can be successfully managed by adherence to established clinical guidelines. This study aimed to evaluate current practices in ACS management, adherence to guidelines and in-hospital outcomes. Methods: This observational, prospective study was conducted at 39 centers in Taiwan. Patients with ACS 20 years) who were admitted to participating hospitals within 24 hours and provided written consent, were enrolled. Disease management/outcome data was collected at admission, during the in-hospital stay, at discharge and at one year post-discharge. Results: Of the 3183 patients enrolled, 52.3% were diagnosed with STEW. Percutaneous coronary intervention and coronary artery bypass grafting were performed on 84.4% and 3.3% of the analyzed population, respectively. Median door-to-needle and door-to-balloon times for invasive management in the STEMI patients were 65 minutes and 96 minutes, respectively. Dual antiplatelet therapy with aspirin and clopidogrel was prescribed to 88.2% of the patients acutely and to 74.8% at discharge. At discharge, beta-blockers were prescribed to 53.4% of patients, statins to 60.5% and RAS blockers to 63.0%. Overall in-hospital mortality was 1.8% and this was higher for STEMI patients (2.3%) than for non-STEMI patients (1.0%). Conclusion: Compared to the ACS management recommended guidelines, median door-to-needle and door-to-balloon times were higher, while secondary preventive therapy during the in-hospital stay and at discharge were suboptimal. There is a need to close the gap between the guidelines and the actual ACS clinical management in Taiwan.