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Romagnoli A, Santoleri F, Costantini A. Adherence and persistence analysis in patients treated with double antiplatelet therapy (DAPT) at two years in real life. PATIENT EDUCATION AND COUNSELING 2021; 104:2012-2017. [PMID: 33461875 DOI: 10.1016/j.pec.2021.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/09/2020] [Accepted: 01/05/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Double antiplatelet therapy (DAPT) is indicated for the treatment of coronary artery diseases (CAD). The optimal duration of therapy with DAPT continues to be a subject of debate in the scientific community. To improve adherence to DAPT, the FDC (fixed dose combination) of Acetylsalicylic acid (ASA) and clopidogrel was developed into a single pill instead of two separate pills thus facilitating the dosage and administration of the therapy and increasing compliance. The aim of this study was to assess adherence and persistence over a period of two years in patients treated with DAPT composed of: ASA/clopidogrel, ASA/prasugrel, ASA/ticagrelor and FDC with ASA and clopidogrel in real life and to assess whether the use of ASA and clopidogrel FDC is associated with improved adherence. MATERIALS AND METHODS In the following retrospective pharmacological-observational non-interventional study, all patients treated with DAPT in the Hospital of Pescara from January 2010 to October 2019 were considered. Persistence to treatment is defined as the duration of time from initiation to discontinuation of treatment. Adherence was calculated as the ratio between Received Daily Dose (RDD) and Prescribed Daily Dose (PDD). RESULTS 277 patients treated with ASA/clopidogrel, 77 patients treated with ASA/prasugrel, 57 patients treated with ASA/ticagrelor and 108 patients treated with FDC of ASA/clopidogrel were analysed. Persistence curves at two years showed a statistically significant difference (p < 0.001). Adherence to therapy was optimal with an absolute value at two years of 0.96. Adherence was better in patients treated with ASA/prasugrel with a value of 0.98 and with 97 % of patients with an adherence value greater than or equal to 0.8, while, it was worse in patients treated with FDC ASA/clopidogrel with an absolute value of 0.94 and with 88 % of patients with an optimal adherence value. No statistically significant difference was found between the ASA/clopidogrel FDC in comparison to each component taken as a separate pill (p = 0.0752). CONCLUSION DAPT along with ASA/clopidogrel showed a statistically significant better persistence than ASA/ticagrelor and ASA/prasugrel. Whereas, to our knowledge and as per the current literature no statistically significant differences were found, in terms of adherence in real life, between the use of ASA/Clopidogrel FDC and the use of two different pills.
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Affiliation(s)
- Alessia Romagnoli
- Hospital Pharmacy of "SS. Spirito" Hospital of Pescara, Address Renato Paolini 47, 65124, Pescara, Italy.
| | - Fiorenzo Santoleri
- Hospital Pharmacy of "SS. Spirito" Hospital of Pescara, Address Renato Paolini 47, 65124, Pescara, Italy.
| | - Alberto Costantini
- Hospital Pharmacy of "SS. Spirito" Hospital of Pescara, Address Renato Paolini 47, 65124, Pescara, Italy.
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Two-year outcomes post-discharge in Asian patients with acute coronary syndrome: Findings from the EPICOR Asia study. Int J Cardiol 2020; 315:1-8. [DOI: 10.1016/j.ijcard.2020.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 02/28/2020] [Accepted: 05/06/2020] [Indexed: 12/29/2022]
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Li YH, Lee CH, Huang WC, Wang YC, Su CH, Sung PH, Chien SC, Hwang JJ. 2020 Focused Update of the 2012 Guidelines of the Taiwan Society of Cardiology for the Management of ST-Segment Elevation Myocardial Infarction. ACTA CARDIOLOGICA SINICA 2020; 36:285-307. [PMID: 32675921 PMCID: PMC7355116 DOI: 10.6515/acs.202007_36(4).20200619a] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/19/2020] [Indexed: 12/22/2022]
Abstract
One of the major missions of the Taiwan Society of Cardiology is to publish practice guidelines that are suitable for local use in Taiwan. The ultimate purpose is to continuously improve cardiovascular health care from the implementation of the recommendations in the guidelines. Despite recent improvement of medical care, patients with ST-segment elevation myocardial infarction (STEMI) still carry a high morbidity and mortality. There have been many changes in the concepts of STEMI diagnosis and treatment in recent years. The 2020 focused update of the 2012 guidelines of the Taiwan Society of Cardiology for the management of STEMI is an amendment of the 2012 guidelines based on the newest published scientific data. The recommendations in this focused update provide the diagnosis and treatment strategy for STEMI that should be generally implemented in Taiwan. Nevertheless, guidelines never completely replace clinical judgment and medical decision still should be determined individually.
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Affiliation(s)
- Yi-Heng Li
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
| | - Cheng-Han Lee
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan
| | - Wei-Chun Huang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
- School of Medicine, National Yang Ming University, Taipei
- Department of Physical Therapy, Fooyin University, Kaohsiung
| | - Yu-Chen Wang
- Division of Cardiology, Department of Internal Medicine, Asia University Hospital
- Department of Biotechnology, Asia University
- Division of Cardiology, Department of Internal Medicine, China Medical University College of Medicine and Hospital
| | - Chun-Hung Su
- Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung
| | - Pei-Hsun Sung
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine
| | - Shih-Chieh Chien
- Department of Critical Care Medicine, MacKay Memorial Hospital, Taipei
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
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Sezavar SH, Hassanzadeh M, Akhlagh Moayed D, Tabandeh M, Ghasemi M, Abdi S, Firoozi I, Golbidi P, Pourjafari M, Taslimi N, Akhlaghi AA, Hashemian M. Current practice of percutaneous coronary intervention on patients with acute coronary syndrome in Iran: A prospective observational study. Med J Islam Repub Iran 2020; 34:13. [PMID: 32551302 PMCID: PMC7293802 DOI: 10.34171/mjiri.34.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Indexed: 11/26/2022] Open
Abstract
Background: Frequent Percutaneous Coronary Intervention (PCI) procedures are being performed on a daily basis in Iran. However, no study has been reported on the current PCI practice in patients with acute coronary syndrome (ACS) in Iran. We aimed to describe the clinical characteristics and treatment patterns in Iranian ACS patients treated with PCI.
Methods: Between February 2017 and July 2017, ACS patients presented to 5 referral hospitals in two major cities of Iran (Tehran and Shiraz) were included in this observational study if aged > 18 years and underwent PCI for ACS during hospitalization; and their clinical and procedural characteristics were collected. All data were entered into SPSS v.21 and descriptive statistics were performed.
Results: Of a total of 314 patients, 228 (73%) were males, 162 (52%) were diagnosed with ST-elevation myocardial infarction and 152 (48%) with Unstable angina/ Non-ST elevation myocardial infarction. Trans-femoral approach was more often (64%) used for PCI procedures. Stent placement was the most frequent (98%) treatment strategy on PCI, with drug-eluting stent selected in the majority of subjects (98%). The overall rate of PCI success was 95%, with 4.1% PCI-related complications, and 1.6% post-PCI bleeding events. The vast majority of the study patients (99%) were discharged with dual anti-platelet therapy.
Conclusion: In this study, we observed a high level of adherence to the currently accepted guidelines in the current PCI practice on ACS patients in Iran. Also we found our practice is highly in line with the global reduction trend in the PCI-related complications.
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Affiliation(s)
- Seyed Hashem Sezavar
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology & Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Hassanzadeh
- Department of Internal Medicine, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Massoud Ghasemi
- Department of Cardiology, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | | | | | - Ali Asghar Akhlaghi
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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Mar GY, Ridderstråle W, Wei J, Liu CP. Safety and Cumulative Incidence of Major Cardiovascular Events with Ticagrelor in Taiwanese Patients with Non-ST-Segment Elevation Myocardial Infarction: A 12-Month, Prospective, Phase IV, Multicenter, Single-Arm Study. ACTA CARDIOLOGICA SINICA 2020; 36:195-206. [PMID: 32425434 DOI: 10.6515/acs.202005_36(3).20191007b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Ticagrelor, an oral, direct-acting, and reversible P2Y12 receptor antagonist, inhibits platelet activation and aggregation. This phase IV, single-arm study analyzed the safety and tolerability of ticagrelor in Taiwanese patients with non-ST-segment elevation myocardial infarction (NSTEMI) during 1 year of follow-up. Methods Patients aged ≥ 20 years with an index event of NSTEMI received ticagrelor (180 mg loading and 90 mg doses twice daily thereafter) plus low-dose aspirin (100 mg/day) for up to 1 year. Safety was evaluated according to adverse events (AEs), serious AEs (SAEs), and PLATO-defined bleeding events. The cumulative incidence of major cardiovascular (CV) events including CV death, myocardial infarction, and stroke was also evaluated. Results The safety population included 108 patients across 13 centers in Taiwan. During treatment, 32 (29.6%) patients had ≥ one PLATO-defined bleeding event. Major bleeding events occurred in seven (6.5%) patients with a Kaplan-Meier (KM) estimated event risk [95% confidence interval (CI)] of 7.1% (3.4%-14.4%), including life-threatening bleeding [four (3.7%) patients] and other major bleeding [three (2.8%) patients]. No PLATO-defined fatal bleeding was observed. SAEs were reported in 23 (21.3%) patients. Six (5.6%) patients experienced major CV events during the 1-year follow-up period, with a KM-estimated event risk (95% CI) of 5.6% (2.6%-12.0%). Conclusions Ticagrelor for up to 1 year was associated with a low rate of major bleeding events and a low incidence of major CV events in Taiwanese patients with NSTEMI. The overall safety of ticagrelor was in accordance with the known safety profile of ticagrelor.
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Affiliation(s)
- Guang-Yuan Mar
- Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.,College of Health and Nursing, Meiho University, Pingtung, Taiwan
| | | | | | - Chun-Peng Liu
- Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan.,College of Health and Nursing, Meiho University, Pingtung, Taiwan
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Ruiz-Nodar JM, Esteve-Pastor MA, Rivera-Caravaca JM, Sandín M, Lozano T, Vicente-Ibarra N, Orenes-Piñero E, Macías MJ, Pernías V, Carrillo L, Candela E, Veliz A, Tello-Montoliu A, Martínez Martínez JG, Marín F. One-year efficacy and safety of prasugrel and ticagrelor in patients with acute coronary syndromes: Results from a prospective and multicentre ACHILLES registry. Br J Clin Pharmacol 2020; 86:1052-1061. [PMID: 31912949 DOI: 10.1111/bcp.14213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/08/2019] [Accepted: 11/04/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Prasugrel and ticagrelor have demonstrated higher efficacy than clopidogrel in their main clinical trials for patients with acute coronary syndrome (ACS). However, the long-term prognosis and different clinical characteristics related to the type of antiplatelet prescription in current clinical practice ACS patients have not been analysed in depth. The objective of this study was to analyse the clinical profile of ACS and the efficacy and safety of novel oral P2Y12 inhibitors in current clinical practice patients discharged afterACS. METHODS We collected data from the ACHILLES registry, and an observational, prospective and multicentre registry of patients discharged after ACS. We analysed baseline characteristics, clinical profile and therapy during ACS admission and compared with the different treatments at discharge. After 1 year of follow-up, ischaemic and major bleeding events were analysed. Multivariate Cox regression analysis and Kaplan Meier curves were also plotted. RESULTS Of 1717 consecutive patients, 1294 (75.4%) were discharged with a P2Y12 inhibitor without oral anticoagulation. Novel oral P2Y12 inhibitors were indicated in 47%. Patients treated with clopidogrel were elderly (69.1 ± 13.4 vs 60.4 ± 11.5 years; P < .001) and had a higher prevalence of cardiovascular risk factors. GRACE and CRUSADE scores were higher in the clopidogrel than in novel oral P2Y12 inhibitors group (P < .001). After 1 year of follow-up, 64(5.0%/year) patients had a new myocardial infarction, 127(10.0%/year) had a major adverse cardiovascular event (MACE) and 78(6.1%/year) died. Patients treated with clopidogrel had a significantly higher annual rate of cardiovascular mortality, MACE and all-cause mortality (allP < .001) without differences in major bleeding (P = .587) compared with novel oral P2Y12 inhibitors. After multivariate adjustment for the main clinical variables related to adverse prognosis in ACS patients, the discharge with novel oral P2Y12 inhibitors therapy was independently associated with lower risk of all-cause mortality (HR0.49, 95% CI [0.24-0.98], P = .044) and lower risk of MACE (HR0.64, 95% CI [0.41-0.98], P = .044). CONCLUSIONS In this prospective, observational and current clinical practice ACS registry, the use of novel oral P2Y12 inhibitors was associated with a reduction in adverse events compared with clopidogrel in patients with ACS. Novel oral P2Y12 inhibitors prescription at discharge was independently associated with lower all-cause mortality and MACE without differences in bleeding events. However, clopidogrel remained the most common P2Y12 inhibitor employed for ACS, especially in older and high-risk patients.
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Affiliation(s)
- Juan Miguel Ruiz-Nodar
- Department of Cardiology. Hospital General Universitario de Alicante. Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante,, Spain
| | - María Asunción Esteve-Pastor
- Department of Cardiology. Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria, CIBER-CV, Murcia, Spain
| | - Jose Miguel Rivera-Caravaca
- Department of Cardiology. Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria, CIBER-CV, Murcia, Spain
| | - Miriam Sandín
- Department of Cardiology. Hospital General Universitario de Alicante. Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante,, Spain
| | - Teresa Lozano
- Department of Cardiology. Hospital General Universitario de Alicante. Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante,, Spain
| | - Nuria Vicente-Ibarra
- Department of Cardiology, Hospital General Universitario de Elche, Alicante, Spain
| | - Esteban Orenes-Piñero
- Department of Cardiology. Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria, CIBER-CV, Murcia, Spain
| | - Manuel Jesús Macías
- Department of Cardiology. Hospital General Universitario de Alicante. Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante,, Spain
| | - Vicente Pernías
- Department of Cardiology, Hospital General Universitario de Elche, Alicante, Spain
| | - Luna Carrillo
- Department of Cardiology. Hospital General Universitario de Alicante. Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante,, Spain
| | - Elena Candela
- Department of Cardiology. Hospital General Universitario de Alicante. Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante,, Spain
| | - Andrea Veliz
- Department of Cardiology. Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria, CIBER-CV, Murcia, Spain
| | - Antonio Tello-Montoliu
- Department of Cardiology. Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria, CIBER-CV, Murcia, Spain
| | - Juan Gabriel Martínez Martínez
- Department of Cardiology. Hospital General Universitario de Alicante. Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante,, Spain
| | - Francisco Marín
- Department of Cardiology. Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria, CIBER-CV, Murcia, Spain
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Zou Y, Yang S, Wang S, Lv B, Xiu L, Li L, Lee SWL, Chin CT, Pocock SJ, Huo Y, Yu B. Prolonged dual antiplatelet therapy in patients with non-ST-segment elevation myocardial infarction: 2-year findings from EPICOR Asia. Clin Cardiol 2020; 43:346-354. [PMID: 31967663 PMCID: PMC7144485 DOI: 10.1002/clc.23322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 11/29/2019] [Accepted: 12/01/2019] [Indexed: 11/15/2022] Open
Abstract
Background Patients with non‐ST‐segment elevation myocardial infarction (NSTEMI) have a generally poor prognosis and antithrombotic management patterns (AMPs) used post‐acute coronary syndrome (ACS) remain unclear. Duration of dual antiplatelet therapy (DAPT) and patient characteristics was evaluated in NSTEMI patients enrolled in EPICOR Asia. Hypothesis Patients stopping DAPT early may benefit from more intensive monitoring. Methods EPICOR Asia was a prospective, real‐world, primary data collection, cohort study in adults with an ACS, conducted in eight countries/regions in Asia, with 2 year follow‐up. Eligible patients were hospitalized within 48 hours of symptom onset and survived to discharge. We describe AMPs and baseline characteristics in NSTEMI patients surviving ≥12 months with DAPT duration ≤12 and > 12 months post‐discharge. Clinical outcomes (composite of death, myocardial infarction, and stroke; and bleeding) were also explored. Results At discharge, 90.8% of patients were on DAPT (including clopidogrel, 99%). At 1‐ and 2‐year follow‐up, this was 79.2% and 60.0%. Patients who stopped DAPT ≤12 months post‐discharge tended to be older, female, less obese, have prior cardiovascular disease, and have renal dysfunction. While causality cannot be inferred, the incidence of the composite endpoint over the subsequent 12 months was 10.6% and 3.1% with shorter vs longer use of DAPT, and mortality risk over the same period was 8.4% and 1.6%. Conclusions Over 90% of NSTEMI patients were discharged on DAPT, with 60% on DAPT at 2 years. Patients stopping DAPT early were more likely to have higher baseline risk and may therefore benefit from more intensive monitoring during long‐term follow‐up.
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Affiliation(s)
- Yanan Zou
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Shuang Yang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Shipeng Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Bo Lv
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Lili Xiu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Lulu Li
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Stephen W-L Lee
- Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
| | - Chee Tang Chin
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Yong Huo
- Peking University First Hospital, Beijing, China
| | - Bo Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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Impact of Optimal Medical Therapy at Discharge on One-year Direct Medical Costs in Patients with Acute Coronary Syndromes: A Retrospective, Observational Database Analysis in China. Clin Ther 2019; 41:456-465.e2. [DOI: 10.1016/j.clinthera.2019.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/08/2018] [Accepted: 01/10/2019] [Indexed: 12/12/2022]
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Li YH, Wang YC, Wang YC, Liu JC, Lee CH, Chen CC, Hsieh IC, Kuo FY, Huang WC, Sung SH, Chiu CZ, Hsu JC, Jen SL, Hwang JJ, Lin JL. 2018 Guidelines of the Taiwan Society of Cardiology, Taiwan Society of Emergency Medicine and Taiwan Society of Cardiovascular Interventions for the management of non ST-segment elevation acute coronary syndrome. J Formos Med Assoc 2018; 117:766-790. [PMID: 30017533 DOI: 10.1016/j.jfma.2018.06.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/25/2018] [Accepted: 06/01/2018] [Indexed: 12/11/2022] Open
Abstract
In Taiwan, the incidence of non-ST segment elevation acute coronary syndrome (NSTE-ACS) continues to increase in recent years. The purpose of this guideline is to help health care professionals in Taiwan to use adequate tests and treatments for management of NSTE-ACS. For rapid diagnosis, in addition to history and physical examination, 0/3 h rapid diagnosis protocol with high sensitivity cardiac troponin assay is recommended in this guideline. Dual antiplatelet and anticoagulation therapies are important parts in the initial treatment. Risk stratification should be performed to identify high risk patients for early coronary angiography. Through evaluation of the coronary anatomy and other clinical factors, the decision for coronary revascularization, either by percutaneous coronary intervention or coronary artery bypass grafting, should be decided by the heart team. The duration of dual antiplatelet therapy should be given for at least 12 months after discharge. Other secondary preventive medications are also recommended for long term use.
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Affiliation(s)
- Yi-Heng Li
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Chen Wang
- Division of Cardiology, Department of Internal Medicine, Asia University Hospital, Taichung, Taiwan; Department of Biotechnology, Asia University, Taichung, Taiwan; Division of Cardiology, Department of Internal Medicine, China Medical University College of Medicine and Hospital, Taichung, Taiwan
| | - Yi-Chih Wang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Ju-Chi Liu
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shuang Ho Hospital and Taipei Medical University, New Taipei City, Taiwan
| | - Cheng-Han Lee
- Department of Internal Medicine and Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University Hospital and College of Medicine, Tainan, Taiwan
| | - Chun-Chi Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - I-Chang Hsieh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Feng-You Kuo
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung and School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Wei-Chun Huang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung and School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Shih-Hsien Sung
- Department of Medicine, Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan
| | - Chiung-Zuan Chiu
- Division of Cardiology, Shin-Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Jung-Cheng Hsu
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Shu-Long Jen
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
| | - Jiunn-Lee Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan; Division of Cardiovascular Medicine, Department of Internal Medicine, Shuang Ho Hospital and Taipei Medical University, New Taipei City, Taiwan.
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Esteve-Pastor MA, Ruíz-Nodar JM, Orenes-Piñero E, Rivera-Caravaca JM, Quintana-Giner M, Véliz-Martínez A, Tello-Montoliu A, PerniasEscrig V, Sandín Rollán M, Vicente-Ibarra N, MacíasVillanego MJ, Candela Sánchez E, Carrillo Alemán L, Lozano T, Valdés M, Marín F. Temporal Trends in the Use of Antiplatelet Therapy in Patients With Acute Coronary Syndromes. J Cardiovasc Pharmacol Ther 2017; 23:57-65. [PMID: 28789568 DOI: 10.1177/1074248417724869] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Current clinical guidelines of acute coronary syndromes (ACS) recommend the use of potent antiplatelet therapy, prasugrel or ticagrelor, because both drugs consistently reduce cardiovascular events. PURPOSE The aim of this study was to examine temporal changes in the use of optimal antiplatelet therapy in patients with ACS. METHODS A total of 1717 consecutive patients admitted for ACS in 3 tertiary hospitals from February 2014 to December 2015 were enrolled. We divided these 23 months into 4 semesters: period I (0-5 months), period II (6-11 months), period III (12-17 months), and period IV (17-23 months). Demographic, clinical, and treatment data were collected both at admission and at discharge. RESULTS Treatment with clopidogrel remained constant throughout the periods (52%, 50%, 44%, and 50% for periods I, II, III, and IV, respectively), whereas a progressive increase in ticagrelor treatment was observed (15%, 25%, 26%, and 28%; P = .001). Indeed, new P2Y12 agents showed an increase from 47% at the first semester to 65% in patients with ST-segment elevation myocardial infarction (STEMI), and in patients younger than 75 years from 36% to 53%. However, for patients older than 75 years, diabetic, and patients with end-stage kidney disease, clopidogrel was the second most commonly used antiplatelet agent. CONCLUSION In this real-life registry of patients with ACS, we observed there is still a high rate of use of clopidogrel, despite guidelines recommendations, and our analyses also showed a trend toward the use of ticagrelor. Patients who received new antiplatelet agents were patients with STEMI, younger than 75 years, and with less comorbidities. However, the use of ticagrelor and prasugrel remains low, highlighting a therapeutic inertia with considerable gap between evidence-based clinical guidelines and daily clinical practice.
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Affiliation(s)
- María Asunción Esteve-Pastor
- 1 Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBER-CV, Murcia, Spain
| | | | - Esteban Orenes-Piñero
- 1 Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBER-CV, Murcia, Spain
| | - José Miguel Rivera-Caravaca
- 1 Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBER-CV, Murcia, Spain
| | - Miriam Quintana-Giner
- 1 Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBER-CV, Murcia, Spain
| | - Andrea Véliz-Martínez
- 1 Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBER-CV, Murcia, Spain
| | - Antonio Tello-Montoliu
- 1 Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBER-CV, Murcia, Spain
| | - Vicente PerniasEscrig
- 3 Department of Cardiology, Hospital General Universitario de Elche, Alicante, Spain
| | - Miriam Sandín Rollán
- 2 Department of Cardiology, Hospital General Universitario de Alicante, Alicante, Spain
| | - Nuria Vicente-Ibarra
- 3 Department of Cardiology, Hospital General Universitario de Elche, Alicante, Spain
| | | | - Elena Candela Sánchez
- 2 Department of Cardiology, Hospital General Universitario de Alicante, Alicante, Spain
| | - Luna Carrillo Alemán
- 2 Department of Cardiology, Hospital General Universitario de Alicante, Alicante, Spain
| | - Teresa Lozano
- 2 Department of Cardiology, Hospital General Universitario de Alicante, Alicante, Spain
| | - Mariano Valdés
- 1 Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBER-CV, Murcia, Spain
| | - Francisco Marín
- 1 Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBER-CV, Murcia, Spain
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11
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Engel J, Damen NL, van der Wulp I, de Bruijne MC, Wagner C. Adherence to Cardiac Practice Guidelines in the Management of Non-ST-Elevation Acute Coronary Syndromes: A Systematic Literature Review. Curr Cardiol Rev 2017; 13:3-27. [PMID: 27142050 PMCID: PMC5324326 DOI: 10.2174/1573403x12666160504100025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/22/2016] [Accepted: 04/25/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In the management of non-ST-elevation acute coronary syndrome (NSTACS) a gap between guideline-recommended care and actual practice has been reported. A systematic overview of the actual extent of this gap, its potential impact on patient-outcomes, and influential factors is lacking. OBJECTIVE To examine the extent of guideline adherence, to study associations with the occurrence of adverse cardiac events, and to identify factors associated with guideline adherence. METHOD Systematic literature review, for which PUBMED, EMBASE, CINAHL, and the Cochrane library were searched until March 2016. Further, a manual search was performed using reference lists of included studies. Two reviewers independently performed quality-assessment and data extraction of the eligible studies. RESULTS Adherence rates varied widely within and between 45 eligible studies, ranging from less than 5.0 % to more than 95.0 % for recommendations on acute and discharge pharmacological treatment, 34.3 % - 93.0 % for risk stratification, and 16.0 % - 95.8 % for performing coronary angiography. Seven studies indicated that higher adherence rates were associated with lower mortality. Several patient-related (e.g. age, gender, co-morbidities) and organization-related (e.g. teaching hospital) factors influencing adherence were identified. CONCLUSION This review showed wide variation in guideline adherence, with a substantial proportion of NST-ACS patients possibly not receiving guideline-recommended care. Consequently, lower adherence might be associated with a higher risk for poor prognosis. Future research should further investigate the complex nature of guideline adherence in NST-ACS, its impact on clinical care, and factors influencing adherence. This knowledge is essential to optimize clinical management of NSTACS patients and could guide future quality improvement initiatives.
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Affiliation(s)
- Josien Engel
- EMGO Institute for Health and Care Research, Department of Public and Occupational Health, VU University Medical Center. Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
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12
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Zeymer U, Becher A, Jennings E, Johansson S, Westergaard M. Systematic review of the clinical impact of dual antiplatelet therapy discontinuation after acute coronary syndromes. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 6:522-531. [DOI: 10.1177/2048872616648467] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Uwe Zeymer
- Klinikum Ludwigshafen, Institut für Herzinfarktforschung, Germany
| | - Anja Becher
- Research and Evaluation Unit, Oxford PharmaGenesis Ltd, UK
- School of Medicine, Pharmacy and Health, Durham University, UK
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13
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Pinnarelli L, Mayer F, Bauleo L, Agabiti N, Kirchmayer U, Belleudi V, Di Martino M, Autore C, Ricci R, Violini R, Fusco D, Davoli M, Perucci CA. Adherence to antiplatelet therapy after percutaneous coronary intervention: a population study in a region of Italy. J Cardiovasc Med (Hagerstown) 2016; 16:230-7. [PMID: 25325532 DOI: 10.2459/jcm.0000000000000070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS We evaluated adherence to dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) for patients in the Lazio region of Italy and the impact of discharge ward type on therapy discontinuation. METHODS From the Hospital Information System, we selected patients who underwent PCI from 2006 to 2007 and obtained Regional Drug Dispense Registry data for antiplatelet drugs prescribed for 12 months after discharge. Appropriate therapy was defined as DAPT with prescribed daily doses for each drug covering at least 75% of each individual follow-up period. The association between discharge ward type and antiplatelet therapy adherence at 12 months post discharge was estimated using multilevel logistic regression analysis. RESULTS A total of 11 186 patients with PCI were included, and fewer than half (4984; 44.56%) were on adequate DAPT. Only 2930 of 5390 patients (54.36%) with DAPT in the first 6 months post discharge continued DAPT in the second 6 months. Patients discharged from cardiology units or intensive coronary care units were more likely (odds ratio = 1.26; P = 0.003) to receive appropriate antiplatelet therapy, and elderly patients were less likely (odds ratio = 0.65; P < 0.001) to do so. CONCLUSION The proportion of PCI patients receiving appropriate DAPT after discharge is suboptimal in this region, and elderly patients are less likely to receive appropriate therapy. These findings could be important for improving patient management and ensuring adherence to clinical guidelines and indicate the need for a systematic evaluation of the appropriateness of postdischarge therapy.
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Affiliation(s)
- Luigi Pinnarelli
- aDepartment of Epidemiology, Lazio Regional Health Service bDivisione di Cardiologia, Università di Roma La Sapienza, Ospedale Sant'Andrea cDepartment of Cardiology, St Spirito Hospital dDepartment of Interventional Cardiology, Azienda Ospedaliera San Camillo Forlanini eNational Agency for Regional Health Services, Rome, Italy
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14
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Byeon HJ, Yang YM, Choi EJ. Optimal medical therapy for secondary prevention after an acute coronary syndrome: 18-month follow-up results at a tertiary teaching hospital in South Korea. Ther Clin Risk Manag 2016; 12:167-75. [PMID: 26929629 PMCID: PMC4758787 DOI: 10.2147/tcrm.s99869] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Acute coronary syndrome (ACS) is a fatal cardiovascular disease caused by atherosclerotic plaque erosion or rupture and formation of coronary thrombus. The latest guidelines for ACS recommend the combined drug regimen, comprising aspirin, P2Y12 inhibitor, angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker, β-blocker, and statin, at discharge after ACS treatment to reduce recurrent ischemic cardiovascular events. This study aimed to examine prescription patterns of secondary prevention drugs in Korean patients with ACS after hospital discharge, to access the appropriateness of secondary prevention drug therapy for ACS, and to evaluate whether to persistently use discharge medications for 18 months. Methods This study was retrospectively conducted with the patients who were discharged from the tertiary hospital, located in South Korea, after ACS treatment between September 2009 and August 2013. Data were collected through electronic medical record. Results Among 3,676 patients during the study period, 494 were selected based on inclusion and exclusion criteria. The regimen of aspirin + clopidogrel + β-blocker + angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker + statin was prescribed to 374 (75.71%) patients with ACS at discharge. Specifically, this regimen was used in 177 (69.69%) unstable angina patients, 44 (70.97%) non-ST-segment elevation myocardial infarction patients, and 153 (85.96%) ST-segment elevation myocardial infarction patients. Compared with the number of ACS patients with all five guideline-recommended drugs at discharge, the number of ACS patients using them 12 (n=169, 34.21%) and 18 (n=105, 21.26%) months after discharge tended to be gradually decreased. Conclusion The majority of ACS patients in this study received all five guideline-recommended medications at discharge from the hospital. However, the frequency of using all of them had been gradually decreased 3, 6, 12, and 18 months after discharge compared with that at discharge. Careful monitoring of adherence on ACS secondary prevention medications may help improve the outcomes of ACS patients in terms of recurrent ischemic cardiovascular events.
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Affiliation(s)
- Hee Ja Byeon
- Department of Pharmacy, Chosun University Hospital, Gwangju, South Korea
| | - Young-Mo Yang
- Department of Pharmacy, College of Pharmacy, Chosun University, Gwangju, South Korea
| | - Eun Joo Choi
- Department of Pharmacy, College of Pharmacy, Chosun University, Gwangju, South Korea
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15
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Gaedke MÂ, Costa JSDD, Manenti ERF, Henn RL, Paniz VMV, Nunes MF, Motta MAD, Olinto MTA. Use of medicines recommended for secondary prevention of acute coronary syndrome. Rev Saude Publica 2016; 49:S0034-89102015000100270. [PMID: 26759968 PMCID: PMC4687825 DOI: 10.1590/s0034-8910.2015049005978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 03/13/2015] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE : To analyze if the demographic and socioeconomic variables, as well as percutaneous coronary intervention are associated with the use of medicines for secondary prevention of acute coronary syndrome. METHODS : In this cohort study, we included 138 patients with acute coronary syndrome, aged 30 years or more and of both sexes. The data were collected at the time of hospital discharge, and after six and twelve months. The outcome of the study was the simultaneous use of medicines recommended for secondary prevention of acute coronary syndrome: platelet antiaggregant, beta-blockers, statins and angiotensin-converting-enzyme inhibitor or angiotensin receptor blocker. The independent variables were: sex, age, education in years of attending, monthly income in tertiles and percutaneous coronary intervention. We described the prevalence of use of each group of medicines with their 95% confidence intervals, as well as the simultaneous use of the four medicines, in all analyzed periods. In the crude analysis, we verified the outcome with the independent variables for each period through the Chi-square test. The adjusted analysis was carried out using Poisson Regression. RESULTS : More than a third of patients (36.2%; 95%CI 28.2;44.3) had the four medicines prescribed at the same time, at the moment of discharge. We did not observe any differences in the prevalence of use in comparison with the two follow-up periods. The most prescribed class of medicines during discharge was platelet antiaggregant (91.3%). In the crude analysis, the demographic and socioeconomic variables were not associated to the outcome in any of the three periods. CONCLUSIONS : The prevalence of simultaneous use of medicines at discharge and in the follow-ups pointed to the under-utilization of this therapy in clinical practice. Intervention strategies are needed to improve the quality of care given to patients that extend beyond the hospital discharge, a critical point of transition in care.
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Affiliation(s)
| | | | | | - Ruth Liane Henn
- Universidade do Vale do Rio dos Sinos, São Leopoldo, RS, Brasil
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16
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Chan MY, Du X, Eccleston D, Ma C, Mohanan PP, Ogita M, Shyu KG, Yan BP, Jeong YH. Acute coronary syndrome in the Asia-Pacific region. Int J Cardiol 2016; 202:861-9. [DOI: 10.1016/j.ijcard.2015.04.073] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 03/26/2015] [Accepted: 04/09/2015] [Indexed: 11/28/2022]
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17
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Kassaian SE, Masoudkabir F, Sezavar H, Mohammadi M, Pourmoghaddas A, Kojouri J, Ghaffari S, Sanaati H, Alaeddini F, Pourmirza B, Mir E. Clinical characteristics, management and 1-year outcomes of patients with acute coronary syndrome in Iran: the Iranian Project for Assessment of Coronary Events 2 (IPACE2). BMJ Open 2015; 5:e007786. [PMID: 26671947 PMCID: PMC4679985 DOI: 10.1136/bmjopen-2015-007786] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To assess contemporary data on characteristics, management and 1-year postdischarge outcomes in Iranian patients hospitalised with acute coronary syndrome (ACS). SETTING 11 tertiary care hospitals in 5 major cities in the Islamic Republic of Iran. PARTICIPANTS Patients aged ≥ 20 and ≤ 80 years discharged alive with confirmed diagnosis of ACS including ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and high-risk unstable angina (HR-UA). PRIMARY AND SECONDARY OUTCOME MEASURES Patients were followed up regarding the use of medications and the end points of the study at 1 month and 1 year after discharge. The primary end point of the study was 1-year postdischarge major adverse cardiac and cerebrovascular events (MACCEs), defined as mortality (cardiac and non-cardiac), ACS and cerebrovascular attack (stroke and/or transient ischaemic attack). The secondary end points were hospital admission because of congestive heart failure, revascularisation by coronary artery bypass grafting surgery or percutaneous coronary intervention (PCI), and major and minor bleeds. RESULTS A total of 1799 patients (25.7% STEMI and 74.3% HR-UA/NSTEMI) discharged alive with confirmed diagnosis of ACS were included in the final analysis. During hospitalisation, the majority of the patients received aspirin (98.6%), clopidogrel (91.8%), anticoagulants (93.4%), statins (94.3%) and β-blockers (89.3%). Reperfusion therapy was performed in 62.6% of patients with STEMI (46.3% thrombolytic therapy and 17.3% primary PCI). The mean door-to-balloon and door-to-needle times were 82.9 and 45.6 min, respectively. In our study, 64.7% and 79.5% of the patients in HR-UA/NSTEMI and STEMI groups, respectively, underwent coronary angiography. During the 12 months after discharge, MACCEs occurred in 15.0% of all patients. CONCLUSIONS Our study showed that the composition of Iranian patients with ACS regarding the type of ACS is similar to that in developed European countries and is unlike that in developing countries of the Middle East and Africa. We found that our patients with ACS are treated with high levels of adherence to guideline-recommended in-hospital medications.
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Affiliation(s)
- Seyed Ebrahim Kassaian
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Masoudkabir
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hashem Sezavar
- Department of Cardiology, Rasul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mohammadi
- Department of Cardiology, Javad-Al-Aemmeh Heart Hospital & Research Center, Mashhad, Iran
| | - Ali Pourmoghaddas
- Department of Cardiology, Khorshid Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Javad Kojouri
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Samad Ghaffari
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamidreza Sanaati
- Department of Cardiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farshid Alaeddini
- Department of Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Elham Mir
- Sanofi Iran Medical Department, Tehran, Iran
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18
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Huo Y, Lee SWL, Sawhney JPS, Kim HS, Krittayaphong R, Nhan VT, Alonso-Garcia A, Han YL, Ge J, Chin CT, Ong TK, Jan S, Itoh Y, Vega AM, Pocock S. Rationale, Design, and Baseline Characteristics of the EPICOR Asia Study (Long-tErm follow-uP of antithrombotic management patterns In Acute CORonary Syndrome patients in Asia). Clin Cardiol 2015. [PMID: 26206158 DOI: 10.1002/clc.22431] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In-hospital and postdischarge mortality for acute coronary syndromes (ACS) vary across Asia and remain generally poorer than globally. The relationship between real-life antithrombotic management patterns (AMPs) and ACS-related outcomes in Asia is unclear. METHODS EPICOR Asia (Long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients in Asia) (NCT01361386) is a prospective, multinational, observational study of patients discharged after hospitalization for an ACS, with 2-year follow-up. The aim is to describe short- and long-term (up to 2 years post-index event) AMPs in patients hospitalized for ACS and to record clinical outcomes, healthcare resource use, and self-reported health status. Pre- and in-hospital management, AMPs, and associated outcomes, with particular focus on ischemic and bleeding events, will be recorded during the 2-year follow up. RESULTS Between June 2011 and May 2012, 13 005 patients were enrolled. From these, 12 922 patients surviving an ACS (6616 with STEMI, 2570 with NSTEMI, and 3736 with UA) were eligible for inclusion from 219 hospitals across 8 countries and regions in Asia: China (n = 8214), Hong Kong (n = 177), India (n = 2468), Malaysia (n = 100), Singapore (n = 93), South Korea (n = 705), Thailand (n = 957), and Vietnam (n = 208). CONCLUSIONS EPICOR Asia will provide information regarding clinical management and AMPs for ACS patients in Asia. Impact of AMPs on clinical outcomes, healthcare resource use, and self-reported health status both during hospitalization and up to 2 years after discharge will also be described.
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Affiliation(s)
- Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Stephen W-L Lee
- Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
| | | | - Hyo-Soo Kim
- Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
| | | | - Vo T Nhan
- Department of Medicine, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Angeles Alonso-Garcia
- Cardiovascular Science Research Centre, St. George's University of London, London, United Kingdom
| | - Ya Ling Han
- Department of Cardiology, Shenyang Northern Hospital, Shenyang, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Shanghai, China
| | - Chee Tang Chin
- Department of Cardiology, National Heart Centre Singapore, Singapore and Duke-NUS Graduate Medical School, Singapore
| | - Tiong K Ong
- Department of Cardiology, Sarawak General Hospital, Kuching, Malaysia
| | - Stephen Jan
- Health Economics Program, The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Yohji Itoh
- Clinical Science Division, AstraZeneca, Osaka, Japan
| | - Ana Maria Vega
- Observational Research Centre, Global Medical Affairs, AstraZeneca, Madrid, Spain
| | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Huo Y, Thompson P, Buddhari W, Ge J, Harding S, Ramanathan L, Reyes E, Santoso A, Tam LW, Vijayaraghavan G, Yeh HI. Challenges and solutions in medically managed ACS in the Asia-Pacific region: expert recommendations from the Asia-Pacific ACS Medical Management Working Group. Int J Cardiol 2014; 183:63-75. [PMID: 25662044 DOI: 10.1016/j.ijcard.2014.11.195] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 11/12/2014] [Accepted: 11/24/2014] [Indexed: 12/26/2022]
Abstract
Acute coronary syndromes (ACS) remain a leading cause of mortality and morbidity in the Asia-Pacific (APAC) region. International guidelines advocate invasive procedures in all but low-risk ACS patients; however, a high proportion of ACS patients in the APAC region receive solely medical management due to a combination of unique geographical, socioeconomic, and population-specific barriers. The APAC ACS Medical Management Working Group recently convened to discuss the ACS medical management landscape in the APAC region. Local and international ACS guidelines and the global and APAC clinical evidence-base for medical management of ACS were reviewed. Challenges in the provision of optimal care for these patients were identified and broadly categorized into issues related to (1) accessibility/systems of care, (2) risk stratification, (3) education, (4) optimization of pharmacotherapy, and (5) cost/affordability. While ACS guidelines clearly represent a valuable standard of care, the group concluded that these challenges can be best met by establishing cardiac networks and individual hospital models/clinical pathways taking into account local risk factors (including socioeconomic status), affordability and availability of pharmacotherapies/invasive facilities, and the nature of local healthcare systems. Potential solutions central to the optimization of ACS medical management in the APAC region are outlined with specific recommendations.
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Affiliation(s)
| | - Yong Huo
- Peking University First Hospital, Beijing, China.
| | - Peter Thompson
- University of Western Australia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
| | - Wacin Buddhari
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Junbo Ge
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Scott Harding
- Wellington Cardiovascular Research Group and School of Biological Sciences, Victoria University, Wellington, New Zealand
| | | | - Eugenio Reyes
- University of the Philippines, Philippine General Hospital-Section of Cardiology, Manila, Philippines
| | - Anwar Santoso
- Department of Cardiology - Vascular Medicine, Faculty of Medicine, University of Indonesia and National Cardiovascular Center, Harapan Kita, Indonesia
| | | | | | - Hung-I Yeh
- Mackay Memorial Hospital, Mackay Medical College, New Taipei City, Taiwan
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20
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Yetgin T, van der Linden MMJM, de Vries AG, Smits PC, van Mechelen R, Yap SC, Boersma E, Zijlstra F, van Geuns RJM. Current discharge management of acute coronary syndromes: data from the Rijnmond Collective Cardiology Research (CCR) study. Neth Heart J 2014; 22:20-7. [PMID: 24155103 PMCID: PMC3890006 DOI: 10.1007/s12471-013-0484-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Medical discharge management of acute coronary syndromes (ACS) remains suboptimal outside randomised trials and constitutes an essential quality benchmark for ACS. We sought to evaluate the rates of key guideline-recommended pharmacological agents after ACS and characteristics associated with optimal treatment at discharge. Methods The Rijnmond Collective Cardiology Research (CCR) registry is an ongoing prospective, observational study in the Netherlands that aims to enrol 4000 patients with ACS. We examined discharge and 1-month follow-up medication use among the first 1000 patients enrolled in the CCR registry. Logistic regression was performed to identify patient and hospital characteristics associated with collective guideline-recommended pharmacotherapy at hospital discharge. Results At discharge, 94 % of patients received aspirin, 100 % thienopyridines, 80 % angiotensin-converting enzyme inhibitors/angiotensin-II receptor blockers, 87 % β-blockers, 96 % statins, and 65 % the combination of all 5 agents. ST-segment elevation myocardial infarction, hypertension, hypercholesterolaemia, and enrolment in an interventional centre were positive independent predictors of 5-drug combination therapy at discharge. Negative independent predictors were unstable angina and advanced age. Conclusion Current data from the CCR registry reflect a high quality of care for ACS discharge management in the Rotterdam-Rijnmond region. However, potential still remains for further optimisation.
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Affiliation(s)
- T. Yetgin
- Department of Cardiology, Erasmus MC, Thoraxcentre, Room Ee-2355, Dr. Molewaterplein 50-60, 3015 GE Rotterdam, The Netherlands
| | - M. M. J. M. van der Linden
- Department of Cardiology, Erasmus MC, Thoraxcentre, Room Ee-2355, Dr. Molewaterplein 50-60, 3015 GE Rotterdam, The Netherlands
- Department of Cardiology, Vlietland Hospital, Vlietlandplein 2, 3118 JH Schiedam, The Netherlands
| | - A. G. de Vries
- Department of Cardiology, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, The Netherlands
| | - P. C. Smits
- Department of Cardiology, Maasstad Hospital, Maasstadweg 21, 3079 DZ Rotterdam, The Netherlands
| | - R. van Mechelen
- Department of Cardiology, Sint Franciscus Gasthuis, Kleiweg 500, 3045 PM Rotterdam, The Netherlands
| | - S. C. Yap
- Department of Cardiology, Erasmus MC, Thoraxcentre, Room Ee-2355, Dr. Molewaterplein 50-60, 3015 GE Rotterdam, The Netherlands
- Department of Cardiology, Erasmus MC, Thoraxcentre, Room Ba-316, ‘s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - E. Boersma
- Department of Cardiology, Erasmus MC, Thoraxcentre, Room Ee-2355, Dr. Molewaterplein 50-60, 3015 GE Rotterdam, The Netherlands
- Department of Cardiology, Erasmus MC, Thoraxcentre, Room Bd-381, ‘s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - F. Zijlstra
- Department of Cardiology, Erasmus MC, Thoraxcentre, Room Ee-2355, Dr. Molewaterplein 50-60, 3015 GE Rotterdam, The Netherlands
- Department of Cardiology, Erasmus MC, Thoraxcentre, Room Ba-593, ‘s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - R.-J. M. van Geuns
- Department of Cardiology, Erasmus MC, Thoraxcentre, Room Ee-2355, Dr. Molewaterplein 50-60, 3015 GE Rotterdam, The Netherlands
- Department of Cardiology, Erasmus MC, Thoraxcentre, Room Ba-585, ‘s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
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Kenaan M, Seth M, Aronow HD, Wohns D, Share D, Gurm HS. The Clinical Outcomes of Percutaneous Coronary Intervention Performed Without Pre-Procedural Aspirin. J Am Coll Cardiol 2013; 62:2083-9. [DOI: 10.1016/j.jacc.2013.08.1625] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 08/17/2013] [Accepted: 08/26/2013] [Indexed: 11/25/2022]
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Chiang FT, Shyu KG, Wu CJ, Mar GY, Hou CJY, Li AH, Wen MS, Lai WT, Lin SJ, Kuo CT, Kuo C, Li YH, Hwang JJ. Predictors of 1-year outcomes in the Taiwan Acute Coronary Syndrome Full Spectrum Registry. J Formos Med Assoc 2013; 113:794-802. [PMID: 24076272 DOI: 10.1016/j.jfma.2013.08.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 08/05/2013] [Accepted: 08/08/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND/PURPOSE Evidence-based guidelines have been formulated for optimal management of acute coronary syndrome (ACS). The Taiwan ACS Full Spectrum Registry aimed to evaluate the ACS management and identify the predictors of clinical outcomes of death/myocardial infarction/stroke 1 year post hospital discharge. METHODS Three thousand and eighty confirmed ACS patients enrolled in this registry were followed up for 1 year at 3-month intervals. Patient data on medical interventions as well as clinical events were recorded and analyzed by descriptive statistics. RESULTS One-year mortality among patients with ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and unstable angina was 6.1%, 10.1%, and 6.2%, respectively. Use of secondary preventive therapies was suboptimal throughout the follow-up phase, especially dual antiplatelet therapy, which fell from 74.8% patients at discharge to 24.9% patients at 1-year follow-up. The odds of an adverse incidence of death/myocardial infarction/stroke 1 year after discharge was significantly reduced in patients receiving aspirin and clopidogrel for ≥9 months and was consequently higher in patients in whom dual antiplatelet therapy was discontinued or prescribed for <9 months. Chronic renal failure, in-hospital bleeding, a diagnosis of NSTEMI, and antiplatelet therapy discontinuation had a negative association with 1-year outcomes, whereas the use of drug-eluting stents and antiplatelet agents, clopidogrel and aspirin, were predictors of positive outcomes. CONCLUSION There is a significant deviation from evidence-based guidelines in ACS management in Taiwan as reported in other countries. Policy adherence, especially with regard to dual antiplatelet therapy may hold the key to long-term favorable outcomes and improved survival rates in ACS patients in Taiwan.
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Affiliation(s)
| | - Kou-Gi Shyu
- Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
| | - Chiung-Jen Wu
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | | | - Charles Jia-Yin Hou
- Mackay Memorial Hospital and Mackay Medicine, Nursing and Management College, Taipei, Taiwan
| | - Ai-Hsien Li
- Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Ming-Shien Wen
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Linkou Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Wen-Ter Lai
- Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
| | | | - Chi-Tai Kuo
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Linkou Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chieh Kuo
- Sin Lau Christian Hospital, Tainan, Taiwan
| | - Yi-Heng Li
- National Cheng Kung University College of Medicine, Tainan, Taiwan; National Cheng Kung University Hospital, Tainan, Taiwan
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