The Management and Prognostic Factors of Acute Coronary Syndrome: Evidence from the Taiwan Acute Coronary Syndrome Full Spectrum Registry

• Published in: Acta Cardiologica Sinica Vol. 33; no. 4; pp. 329 - 338
• Main Authors: Chu, Chun-Yuan, Lin, Tsung-Hsien, Lai, Wen-Ter
• Format: Journal Article
• Language: English
• Published: 台灣 中華民國心臟學會 01-07-2017; Taiwan Society of Cardiology
• Subjects: Bleeding; CHA2DS2-VASc; Chronic kidney disease; Diabetes; MEDLINE; NSTE-ACS; Review; SCI; Scopus; Taiwan Acute Coronary Syndrome Full Spectrum Registry; Chronic kidney disease; NSTE-ACS; Diabetes; Taiwan Acute Coronary Syndrome Full Spectrum Registry; CHA_2DS_2-VASc; Bleeding; CHA2DS2-VASc
• ISSN: 1011-6842
• DOI: 10.6515/ACS20161205A

Cardiovascular disease (CVD) accounts for approximately one-third of all global deaths, and acute coronary syndrome (ACS) is the most severe form of CVD. It is of notable importance to develop ACS strategies for reducing major adverse cardiac events (MACE) and preventing complications. In the Taiwan ACS Full Spectrum Registry, 1-year mortality among patients with ST-segment elevation myocardial infarction, non ST-segment elevation myocardial infarction and unstable angina was 6.1%, 10.1%, and 6.2%, respectively. ACS patientswith diabetes had significantly worse outcomes in terms of all-cause death and MACE compared to those without diabetes. In-hospital bleeding or chronic kidney disease (CKD) was independently associated with MACE, and ACS patients with both bleeding and CKD had the worst outcome. Use of clopidogrel in conjunction with an invasive strategy could decrease mortality and improve outcomes in the CKD population. CHADS_2 and CHA_2DS_2-VASc scores were useful predictors of subsequent MACE, and renal dysfunction could further improve the prognostic impact of the CHA_2DS_2-VASc score. For high-risk patients with non-ST-elevation acute coronary syndrome (NSTE-ACS), percutaneous coronary intervention (PCI) within 24-72 hours from symptom onset was demonstrably the optimal time. Suboptimal secondary preventive therapy demonstrated a need for further improvement. The ACS Full Spectrum Registry provided an in-depth analysis of ACS management in Taiwan.