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 STEMI. 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.