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

被引：20

作者：

Chen, Kuan-Chun ^{[1
,2
]}

Yin, Wei-Hsian ^{[3
,4
]}

Wu, Chih-Cheng ^{[5
,6
]}

Chan, Shih-Hung ^{[7
]}

Wu, Yen-Wen ^{[8
,9
]}

Wang, Kuo Yang ^{[10
]}

Chang, Kuan-Cheng ^{[11
,12
]}

Hwang, Juey-Jen ^{[13
]}

Voon, Wen-Chol ^{[14
]}

Hsieh, I-Chang ^{[15
,16
]}

Chong, Jun-Ted ^{[17
]}

Lin, Wei-Shiang ^{[18
,19
]}

Hsu, Chih-Neng ^{[20
]}

Ueng, Kwo-Chang ^{[21
]}

Hsia, Chih-Ping ^{[22
]}

Liu, Ju-Chi ^{[23
,24
]}

Yeh, Jong-Shivan ^{[23
,25
]}

Mar, Guang-Yuan ^{[26
]}

Shih, Jhih-Yuan ^{[27
]}

Kuo, Jen-Yuan ^{[28
,29
]}

Tsao, Hsuan-Ming ^{[30
]}

Tseng, Wei-Kung ^{[31
]}

Yang, Cheng-Hsu ^{[32
]}

Chang, Chao-Chien ^{[33
,34
,35
]}

Chiang, Chern-En ^{[36
]}

Lei, Meng-Heng ^{[37
]}

Lin, Jeng-Feng ^{[38
]}

Shyu, Kou-Gi ^{[39
]}

机构：

[1] Cheng Hsin Gen Hosp, Heart Ctr, Div Cardiol, Taipei, Taiwan

[2] Natl Yang Ming Univ, Sch Med, Inst Emergency & Crit Care Med, Taipei, Taiwan

[3] Natl Yang Ming Univ, Cheng Hsin Gen Hosp, Heart Ctr, Div Cardiol, Taipei, Taiwan

[4] Natl Yang Ming Univ, Sch Med, Fac Med, Taipei, Taiwan

[5] Natl Taiwan Univ, Natl Taiwan Univ Hosp, Coll Med, Cardiovasc Ctr,Hsinchu Branch, Taipei, Taiwan

[6] Natl Tsing Hua Univ, Inst Biomed Engn, Hsinchu, Taiwan

[7] Natl Cheng Kung Univ, Natl Cheng Kung Univ Hosp, Coll Med, Dept Internal Med, Tainan, Taiwan

[8] Far Eastern Mem Hosp, Cardiovasc Med Ctr, Cardiol Div, New Taipei, Taiwan

[9] Natl Yang Ming Univ, Sch Med, Taipei, Taiwan

[10] China & Chung Shan Med Univ, Taichung Vet Gen Hosp, Cardiovasc Ctr, Dept Med, Taichung, Taiwan

[11] China Med Univ, Grad Inst Biomed Sci, Taichung, Taiwan

[12] China Med Univ Hosp, Div Cardiovasc Med, Taichung, Taiwan

[13] Natl Taiwan Univ, Dept Internal Med, Cardiovasc Div, Coll Med & Hosp, Taipei, Taiwan

[14] Kaohsiung Med Univ, Dept Internal Med, Div Cardiol, Chung Ho Mem Hosp, Kaohsiung, Taiwan

[15] Chang Gung Mem Hosp, Div Cardiol, Linkou, Taiwan

[16] Chang Gung Univ, Taoyuan, Taiwan

[17] PingTung Christian Hosp, Pingtung, Taiwan

[18] Triserv Gen Hosp, Div Cardiol, Taipei, Taiwan

[19] Natl Def Med Ctr, Taipei, Taiwan

[20] Natl Taiwan Univ Hosp, Dept Internal Med, Div Cardiol, Yunlin Branch, Taipei, Taiwan

[21] Chung Shan Med Univ Hosp, Dept Internal Med, Taichung, Taiwan

[22] Kuang Tien Gen Hosp, Taichung, Taiwan

[23] Taipei Med Univ, Coll Med, Sch Med, Dept Internal Med, Taipei, Taiwan

[24] Taipei Med Univ, Shuang Ho Hosp, Dept Internal Med, Div Cardiol, Taipei, Taiwan

[25] Taipei Med Univ, Dept Internal Med, Div Cardiovasc Med, Wanfang Hosp, Taipei, Taiwan

[26] Kaohsiung Vet Gen Hosp, Div Cardiol, Kaohsiung, Taiwan

[27] Chimei Med Ctr, Div Cardiovasc Med, Tainan, Taiwan

[28] MacKay Mem Hosp, Dept Internal Med, Div Cardiol, Taipei, Taiwan

[29] Mackay Med Coll, New Taipei, Taiwan

[30] Natl Yang Ming Univ Hosp, Yilan, Taiwan

[31] E Da Hosp, Dept Internal Med, Div Cardiol, Kaohsiung, Taiwan

[32] Kaohsiung Chang Gung Mem Hosp, Dept Internal Med, Sect Cardiol, Kaohsiung, Taiwan

[33] Cathay Gen Hosp, Dept Internal Med, Div Cardiol, Taipei, Taiwan

[34] Taipei Med Univ, Coll Med, Grad Inst Med Sci, Taipei, Taiwan

[35] Taipei Med Univ, Coll Med, Dept Pharmacol, Taipei, Taiwan

[36] Taipei Vet Gen Hosp, Div Cardiol, Taipei, Taiwan

[37] Lo Tung Poh Ai Hosp, Luodong, Taiwan

[38] Taipei Tzu Chi Hosp, Buddhist Tzu Chi Med Fdn, Div Cardiol, New Taipei, Taiwan

[39] Shin Kong Wu Ho Su Mem Hosp, Div Cardiol, 95 Wen Chang Rd, Taipei, Taiwan

来源：

ACTA CARDIOLOGICA SINICA | 2018年 / 34卷 / 03期

关键词：

Acute coronary syndrome; Guideline-directed medical therapy; Oral anti-diabetic drug; Outcome; Type; 2; diabetes; ACUTE MYOCARDIAL-INFARCTION; LONG-TERM PROGNOSIS; ALL-CAUSE MORTALITY; CARDIOVASCULAR OUTCOMES; SECONDARY PREVENTION; TEMPORAL TRENDS; BLADDER-CANCER; MELLITUS; SULFONYLUREAS; DISEASE;

D O I：

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

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

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 DM recruited in the Taiwan ACS-full spectrum (ACS-FS) Registry, which was performed between 2008 and 2010. Results: Compared to the DM patients 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.

引用

页码：211 / 223

页数：13

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