Lin Wen-Yu, Hung Yuan, Lin Gen-Min, Lin Chin-Sheng, Liou Jun-Ting, Cheng Cheng-Chung, Tsai Tsung-Neng, Tsai Wei-Che, Lin Tzu-Chiao, Liu Wen-Cheng, Liu Pang-Yen, Wu Keng-Yi, Hsu Chih-Hsueng, Yu Fang-Han, Cheng Shu-Meng, Yang Shih-Ping, Lin Wei-Shiang, Wu Chun-Hsien
Division of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei.
Department of Medicine, Hualien Armed Forces General Hospital, Hualien, Taiwan.
Acta Cardiol Sin. 2021 Jul;37(4):365-376. doi: 10.6515/ACS.202107_37(4).20210118F.
The Taiwan Society of Cardiology (TSOC) has established multicenter registries for coronary artery disease (CAD) to investigate clinical characteristics, management and risks for mortality. However, the impacts of newly-emerged evidence-based therapies, including the use of drug-eluting stents (DESs), on patients with CAD in Taiwan remain unclear.
The Tri-Service General Hospital-Coronary Heart Disease (TSGH-CHD) registry is a single-center, prospective, longitudinal registry in Taiwan containing data from 2014-2016. Individuals who were admitted for coronary angiography were enrolled. Patient profiles, management and in-hospital outcome data were collected.
We included 3352 patients: 2349 with stable angina and 1003 with acute coronary syndrome (ACS). In the stable angina group, both patients receiving stenting and those receiving medical treatment had a 0.7% mortality rate; DESs were used in 70.4% of the patients receiving stenting. In the ACS group, the patients receiving stenting and those receiving medical treatment had a 4.9% and 10.7% mortality rate, respectively; DESs were used in 63.1% of the patients receiving stenting. In the 2008-2010 Taiwan ACS registry, DESs were used in only 28% of all stenting procedures, and the estimated hospital mortality rate was 1.8%. Multivariate analysis indicated that older age, prior stroke, and cardiogenic shock on admission were associated with an increased risk of in-hospital mortality in the ACS group.
Compared with the Taiwan ACS cohort, the TSGH-CHD registry revealed increased DES use and increased disease complexity and severity after 2010. Although unlikely to significantly improve survival, interventionists seemed to perform high-risk procedures for complex CAD more often in the new DES era.
台湾心脏病学会（TSOC）已建立冠状动脉疾病（CAD）多中心注册登记系统，以调查临床特征、治疗管理及死亡风险。然而，包括药物洗脱支架（DES）使用在内的新出现的循证治疗对台湾CAD患者的影响仍不明确。
三军总医院冠心病（TSGH-CHD）注册登记系统是台湾一个单中心、前瞻性、纵向注册登记系统，包含2014年至2016年的数据。纳入因冠状动脉造影而入院的个体。收集患者资料、治疗管理及住院结局数据。
我们纳入了3352例患者：2349例稳定型心绞痛患者和1003例急性冠状动脉综合征（ACS）患者。在稳定型心绞痛组中，接受支架植入术和接受药物治疗的患者死亡率均为0.7%；接受支架植入术的患者中有70.4%使用了DES。在ACS组中，接受支架植入术和接受药物治疗的患者死亡率分别为4.9%和10.7%；接受支架植入术的患者中有63.1%使用了DES。在2008 - 2010年台湾ACS注册登记系统中，所有支架植入手术中仅28%使用了DES，估计住院死亡率为1.8%。多因素分析表明，年龄较大、既往有卒中史及入院时心源性休克与ACS组住院死亡风险增加相关。
与台湾ACS队列相比，TSGH-CHD注册登记系统显示2010年后DES使用增加，疾病复杂性和严重程度增加。尽管不太可能显著提高生存率，但在新的DES时代，介入医生似乎更频繁地对复杂CAD进行高风险手术。
