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

Li, Yi‐Heng; Wang, Yu-Chen; Wang, Yi‐Chih; Liu, Ju-Chi; Lee, Cheng‐Han; Chen, Chun‐Chi; Hsieh, I‐Chang; Kuo, Feng-You; Huang, Wei-Chun; Sung, Shih‐Hsien; Chiu, Chiung-Zuan; Hsu, Jung-Cheng; Jen, Shu-Long; Hwang, Juey-Jen; Lin, Jiunn‐Lee

doi:10.1016/j.jfma.2018.06.002

Cited by 36 publications

(36 citation statements)

References 162 publications

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“…Currently, the standard treatment for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) is dual antiplatelet therapy (DAPT) with aspirin plus P2Y12 inhibitor [1][2][3]. Compared with aspirin monotherapy, DAPT for 12 months reduces the risk of recurrent major ischemic events in patients with ACS [4].…”

Section: Introductionmentioning

confidence: 99%

“…Ticagrelor was introduced to Taiwan in 2013 and gradually became the first-line P2Y12 inhibitor for ACS [12]. Currently, clopidogrel is mainly used for patients with a high bleeding risk, such as old age, low body weight, concomitant use of oral anticoagulant, and prior major bleeding history [3]. However, ticagrelor was not commonly used in Japan and Korea because of the bleeding risk involved.…”

Section: Introductionmentioning

confidence: 99%

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P2Y12 Inhibitor Monotherapy with Clopidogrel versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Chen

Feng

et al. 2020

JCM

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Background: P2Y12 inhibitor monotherapy is an alternative antiplatelet strategy in patients undergoing percutaneous coronary intervention (PCI). However, the ideal P2Y12 inhibitor for monotherapy is unclear. Methods and Results: We performed a multicenter, retrospective, observational study to compare the efficacy and safety of monotherapy with clopidogrel versus ticagrelor in patients with acute coronary syndrome (ACS) undergoing PCI. From 1 January 2014 to 31 December 2018, 610 patients with ACS who received P2Y12 monotherapy with either clopidogrel (n = 369) or ticagrelor (n = 241) after aspirin was discontinued prematurely were included. Inverse probability of treatment weighting was used to balance covariates between the groups. The primary endpoint was the composite of all-cause mortality, recurrent ACS or unplanned revascularization, and stroke within 12 months after discharge. Overall, 84 patients reached the primary endpoint, with 57 (15.5%) in the clopidogrel group and 27 (11.2%) in the ticagrelor group. Multivariate adjustment in Cox proportional-hazards models revealed a lower risk of the primary endpoint with ticagrelor than with clopidogrel (adjusted hazard ratio (aHR): 0.67, 95% confidence interval (CI): 0.49–0.93). Ticagrelor significantly reduced the risk of recurrent ACS or unplanned revascularization (aHR: 0.46, 95% CI: 0.28–0.75). No significant difference in all-cause mortality and major bleeding events was observed between the 2 groups. Conclusions: Among patients with ACS undergoing PCI who cannot complete course of dual antiplatelet therapy, a significantly lower risk of cardiovascular events was associated with ticagrelor monotherapy than with clopidogrel monotherapy. The major bleeding risk was similar in both the groups.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

P2Y12 Inhibitor Monotherapy with Clopidogrel versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Chen

Feng

et al. 2020

JCM

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“…Five guidelines were from European continent, 1,12-15 two from the United Kingdom, 16,17 six from the United States, [18][19][20][21][22][23] one from Canada, 24 one from Australia and New Zealand, 25 two from Japan, 26,27 and one from Taiwan. 28…”

Section: Selected Guidelinesmentioning

confidence: 99%

Critical appraisal of guidelines for coronary artery disease on dual antiplatelet therapy: More consensus than controversies

Zhang

Zhou

Zhuang

et al. 2019

Clinical Cardiology

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Background Dual antiplatelet therapy (DAPT) in the form of aspirin plus a P2Y12 inhibitor, when indicated, is one of the key treatments in coronary artery disease (CAD). Many recommendations on DAPT in patients with CAD based on current guidelines are largely inconsistent. In our current study, we aimed at systematically reviewing DAPT‐relevant clinical practice guidelines, and highlighting their commonalities and differences for better informed decision‐making. Methods Contemporary guidelines in English were searched in MEDLINE, Embase and websites of guideline organizations and professional societies. Guidelines with recommendations on DAPT for CAD patients were included. Guideline quality was appraised with the 6‐domain Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. The reporting of conflicts of interest (COI) was assessed individually with supplementary items from the RIGHT (Reporting Item for Practice Guidelines in Healthcare) checklist. Meanwhile, extraction of recommendations was performed. Results A total of 18 guidelines fulfilled our inclusion criteria. Most of them were graded with relatively good scores averaging from 42% to 74%. Domains for lower scores were in “stakeholder involvement” and “application.” The reporting of COI was satisfactory. For the recommendations on DAPT, most guidelines with high AGREE II scores included consistent recommendations on the timing and P2Y12 inhibitor selection. Nonetheless, conflicts still exist on the duration of DAPT. Conclusions Quality of guidelines for DAPT in CAD was relatively high, though defects existed in “Applicability” and “Stakeholder Involvement.” As these guidelines developed, DAPT recommendations gradually converged on a consensus. Clinical decision should be made on an individual basis.

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“…AMI includes ST segment elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI). In Taiwan, the incidence of NSTEMI continues to increase in recent years and the cases of NSTEMI outnumbered STEMI [3]. Electrocardiogram (ECG) and cardiac enzymes are important tools to help physicians make differential diagnosis for STEMI and NSTEMI.…”

Section: Introductionmentioning

confidence: 99%

Upstroke Time Per Cardiac Cycle as A Novel Parameter for Mortality Prediction in Patients with Acute Myocardial Infarction

Hsu

Lee

Tsai

et al. 2020

JCM

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Background: Acute myocardial infarction (AMI) is one of the leading causes of death in the world. How to simply predict mortality for AMI patients is important because the appropriate treatment should be done for the patients with higher risk. Recently, a novel parameter of upstroke time per cardiac cycle (UTCC) in lower extremities was reported to be a good predictor of peripheral artery disease and mortality in elderly. However, there was no literature discussing the usefulness of UTCC for prediction of cardiovascular (CV) and overall mortality in AMI patients. Methods: 184 AMI patients admitted to the cardiac care unit were enrolled. Ankle-brachial index (ABI) and UTCC were measured by an ABI-form device in the same day of admission. Results: The median follow-up to mortality was 71 months. There were 36 CV and 124 overall mortality. Higher UTCC was associated with increased CV and overall mortality after multivariable analysis (P = 0.033 and P < 0.001, respectively). However, ABI was only associated with CV mortality and overall mortality in the univariable analysis but became insignificant after the multivariable analysis. In addition, after adding UTCC into a basic model including important clinical parameters, left ventricular ejection fraction, Charlson comorbidity index, and ABI, we found the basic model + UTCC had a better predictive value for overall mortality than the basic model itself (P < 0.001). Conclusions: Our study is the first one to evaluate the usefulness of UTCC in AMI patients for prediction of long-term mortality. Our study showed UTCC was an independent predictor of long-term CV and overall mortality and had an additive predictive value for overall mortality beyond conventional parameters. Therefore, screening AMI patients by UTCC might help physicians to identify the high-risk group with increased mortality.

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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

Cited by 36 publications

References 162 publications

P2Y12 Inhibitor Monotherapy with Clopidogrel versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

P2Y12 Inhibitor Monotherapy with Clopidogrel versus Ticagrelor in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Critical appraisal of guidelines for coronary artery disease on dual antiplatelet therapy: More consensus than controversies

Upstroke Time Per Cardiac Cycle as A Novel Parameter for Mortality Prediction in Patients with Acute Myocardial Infarction

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