Evaluation of Drug Therapy and Adherence to It in Patients after Acute Coronary Syndrome in Real Clinical Practice (Results of One Year Observation)

Aim. To study the prescribed drug therapy, as well as adherence to it in patients with acute coronary syndrome (ACS) in real clinical practice within a year after the index event. Material and methods. The study included 327 patients who were in hospital treatment with ACS: 199 patients (60.9%) with unstable angina (UA) and 128 (39.1%) – with acute myocardial infarction (AMI). The prescribed treatment and adherence to therapy were evaluated within 12 months after the coronary event. Therapy prescribed to patients was compared with current clinical guidelines for the treatment of patients with ACS. Results. 67% of patients completed the clinical study Adherence to prescribed medication within 12 months after ACS was maximal for ACE inhibitors/angiotensin receptor blockers (83.6%), dual antiplatelet therapy (79.9%) and β-blockers (78.1%), and minimal for lipid-lowering drugs (statins; 61.6%). A significant decrease in adherence was revealed in 6 and 12 months from the initiation of therapy. Significantly higher level of adherence to DAT was found in patients with AMI compared with patients with UA (p<0.05). When analyzing the frequency of occurrence of endpoints, it was found that patients who did not adhere to treatment significantly more often had hospitalizations due to UA (15.1% vs 7.4%; p<0.05), AMI (16.9% vs 8.1%; p<0.05), death from cardiovascular causes (13% vs 10.4%; p<0.05). Conclusion. Therapy prescribed at the outpatient stage in patients with ACS in the Rostov Region corresponds to the modern clinical recommendations. Six months after hospital discharge adherence to drug therapy in patients is reduced, which requires more careful outpatient monitoring during this period. In patients who are not adherent to treatment, cardiovascular complications are significantly more frequent.

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Treatment of patients with acute coronary syndrome in real clinical practice in the Republic of Karelia: 10-years registry results

Cardiosomatics ◽

10.26442/22217185.2020.4.200527 ◽

2021 ◽

Vol 11 (4) ◽

pp. 15-19

Author(s):

Inga S. Skopets ◽

Natalia N. Vezikova ◽

Tamazi D. Karapetian ◽

Andrew V. Malafeev ◽

Aleksandr N. Malygin ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Clinical Practice ◽

Drug Therapy ◽

Hospital Mortality ◽

Coronary Syndrome ◽

Cardiovascular Center ◽

St Elevation ◽

The Republic ◽

Real Clinical Practice

Aim. To present the treatment of Acute coronary syndrome (ACS) in clinical practice in the Republic of Karelia and the results of Cardiovascular centers working. Material and methods. The prospective study included 9949 patients successively hospitalized from 01.01.2020 to 01.01.2020 in the Regional cardiovascular center (Petrozavodsk, Russia), 6335 were included in Federal register. Risk factors, clinical features, reperfusion strategy as well as the rate of clinical complications, drug therapy and outcomes were assessed. Results. 9949 patients were treated in Regional cardiovascular center from 01.01.2010 to 01.01.2020 due to acute coronary syndrome, and 6335 were included to the Federal registry. 40.2% of patients had ST-elevation Myocardial Infarction and 59.8% ACS without ST elevation. The first group was younger (the average age was 69) than the second (the average age was 74). The drug therapy of ACS in the hospital was following: 98.7% of patients took aspirin; b-blockers 92.3%, statins 97.4%. The outcomes of ACS during the hospital discharge were following: Q-wave myocardial infarction (MI) was diagnosed in 34.2% cases, non-Q-wave MI in 23.4%, unstable angina 20.5%, repeated MI 18.7% and 2.5% MI unspecified localization. The analysis of the clinical features of ACS shows that significant number of patients (24.8%) had severe complications. So, ventricle arrhythmias were diagnosed in 17.3% of cases, acute left ventricle insufficiency in 7.6%, cardiogenic shock in 3.0%, cardiac arrest in 1.9%, myocardial rupture in 0.4%. The hospital mortality rate reached 6.38%. Conclusion. The article presents data about treatment of patients with acute coronary syndrome in real clinical practice in the Republic of Karelia based on 10-years register. Difficulties of management and reperfusion interventions, the volume of drug therapy, the frequency of complications, as well as outcomes and hospital mortality are discussed. The presented data show the results of modernization of the medical care program for patients with acute coronary syndrome in practical healthcare in the region.

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The lipid-lowering treatment after acute coronary syndrome in the real clinical practice: possible role of the pharmacogenetic interactions

Medical news of the North Caucasus ◽

10.14300/mnnc.2019.14107 ◽

2019 ◽

Vol 14 (3) ◽

Author(s):

Victoria Brazhnik ◽

Larisa Minushkina ◽

Anastasia Alexandrovna Rogozhina ◽

Anastasia Averkova ◽

Ekaterina Zubova ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Clinical Practice ◽

Lipid Lowering ◽

The Real ◽

Coronary Syndrome ◽

Real Clinical Practice

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Assessment of the effectiveness of treatment in patients after acute coronary syndrome

Russian Journal of Cardiology ◽

10.15829/1560-4071-2020-2-3405 ◽

2020 ◽

Vol 25 (2) ◽

pp. 9-18

Author(s):

D. A. Shvets ◽

S. V. Povetkin ◽

A. Yu. Karasev ◽

V. I. Vishnevsky

Keyword(s):

Acute Coronary Syndrome ◽

Drug Therapy ◽

Coronary Artery ◽

Coronary Angiography ◽

Secondary Prevention ◽

Generic Drugs ◽

Myocardial Revascularization ◽

Cardiovascular Complications ◽

Drug Prevention ◽

Coronary Syndrome

Aim. To assess the effectiveness of secondary drug prevention and surgical myocardial revascularization in patients with coronary artery disease (CAD) during long-term follow-up after acute coronary syndrome (ACS).Material and methods. The study involved 400 patients with ACS discharged from the hospital in 2012-2016. The diagnosis was verified according to the European Society of Cardiology (ESC) guidelines. There were no exclusion criteria. We analyzed the data of medical records (complaints, medical history, physical examination, laboratory and instrumental data). Repeated data collection was carried out by distance survey and during a face-to-face examination during 2018. According to the clinical course of CAD, all patients were divided into 2 groups. Group 1 consisted of 151 patients with complicated course of CAD, group 2 — 249 patients with stable CAD. We analyzed drug therapy recommended at hospital discharge and taken at the time of the repeated examination. The drug names and daily dosage used for the secondary prevention of CAD were recorded. Assessment of survival without cardiovascular complications was carried out according to the Kaplan-Mayer analysis.Results. Seven-year mortality was 22,5%. The total number of cardiovascular events was 37,7%. The main reason for the frequent complications was the insufficient secondary prevention of CAD after ACS. We found that the drugs and their dosage did not have a significant effect on survival. Statin use is associated with a paradoxical increase in the number of complications. The increased frequency of use and dosage of statins are a consequence of unfavorable course of CAD and do not have the proper preventive effect. For some groups of drugs, we observed irregular intake over the observation period. The low effectiveness of therapy is not only due to insufficient doses, but also in the frequent use of generic drugs. The significant effect of coronary angiography on the probability of cardiovascular complications compared with stenting is due to high proportion of coronary angiography use without revascularization.Conclusion. The combination of following factors of drug therapy can explain the low effectiveness of secondary CAD prevention: low dose (26,1±2,8 mg for atorvastatin), irregular intake and common use of generic drugs (97,6% for statins), present in different ratios. The contribution of surgical treatment to reducing cardiovascular complications is lower, the more significant residual coronary artery stenosis.

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PCSK9 inhibitors for in-hospital treatment of patients with acute coronary syndrome and severe lipid metabolism disorders

Russian Journal of Cardiology ◽

10.15829/1560-4071-2020-4010 ◽

2020 ◽

Vol 25 (8) ◽

pp. 4010

Author(s):

O. L. Barbarash ◽

N. V. Fedorova ◽

D. Yu. Sedykh ◽

O. V. Gruzdeva ◽

O. N. Khryachkova ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Statin Therapy ◽

Lipid Lowering ◽

High Density Lipoproteins ◽

Hospital Treatment ◽

Lipid Lowering Therapy ◽

Pcsk9 Inhibitor ◽

Coronary Syndrome ◽

Lowering Therapy ◽

Baseline Values

Aim. To assess the efficacy and safety of PCSK9 inhibitor alirocumab as part of a combination lipid-lowering therapy in patients with acute coronary syndrome (ACS).Material and methods. This prospective, open-label, single-center activetreatment study included 13 patients hospitalized due to ACS. The main inclusion criterion was nonachievement of target low-density lipoprotein cholesterol (LDL-C) values (<1,4 mmol/L) with high-intensity statin therapy prior to ACS. During the first 30 days after ACS, all patients received therapy with atorvastatin 40-80 mg/day or rosuvastatin 20-40 mg/day in combination with alirocumab 150 mg/ml (Praluent) administered by subcutaneous injection. Lipid and biochemical profiles were monitored. The first injection of the PCSK9 inhibitor was performed on days 3-5 of hospitalization, the second — after 2 weeks.Results. On admission, the median LDL-C was 4,3 [3,5;5,3] mmol/L. A day after administration, there was a decrease in LDL-C by 41,9% (median 2,5 [1,8;3,2] mmol/L; p=0,001) without a negative effect on high-density lipoproteins (HDL-C) (median 1,2 [0,8;1,4] mmol/L; p=0,270). Before the next injection, LDL-C decreased by another 8% (median 2,3 [1,1;4,1] mmol/L). A day after the second injection, a decrease in LDL-C from the baseline values was 69,8% (median 1,3 [0,7;1,5] mmol/L; p=0,010). Strengthening lipid-lowering therapy with a PCSK9 inhibitor within 30 days after ACS did not lead to clinical and biochemical deterioration.Conclusion. The use of subcutaneous 150-mg injections of alirocumab 2 times a week 30 days after ACS in patients who did not reach target LDL-C values with statin therapy, leads to a 69% decrease in LDL-C from baseline values and is safe.

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Possibilities of combination lipid-lowering therapy in a patient with very high cardiovascular risk (сlinical case)

Consilium Medicum ◽

10.26442/20751753.2021.1.200604 ◽

2021 ◽

Vol 23 (1) ◽

pp. 70-73

Author(s):

Daria Yu. Sedykh ◽

◽

Natalia V. Fedorova ◽

Vasily V. Kashtalap ◽

◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Clinical Practice ◽

Cardiovascular Risk ◽

Lipid Lowering ◽

Lipid Lowering Therapy ◽

High Cardiovascular Risk ◽

Coronary Syndrome ◽

Lowering Therapy ◽

Lipid Metabolism Disorders ◽

Very High

The article demonstrates the possibility of prescribing an effective and safe lipid-lowering combination of the most tolerated doses of statins in combination with ezetimibe, using the example of a patient with severe lipid metabolism disorders in the post-infarction period. It has been shown that in real clinical practice, patients with acute coronary syndrome and persisting high LDL values are quite common, despite of the prescription of statins. These patients need closer follow-up and wider use of combined lipid-lowering therapy by adding ezetimibe to maximally tolerated doses of statins. Current clinical guidelines allow this to be done when patients fail to achieve target LDL values (>1.4 mmol/L) with statins monotherapy. This approach is effective and safe, which is illustrated by this hereditary clinical case. In routine clinical practice mandatory lipids control is required 4–6 weeks after patient’s discharge from the hospital for acute coronary syndrome. If the target lipids values were not achieved with the maximum dosage of statins, a mandatory using the combination therapy with ezetimibe is required. Keywords: myocardial infarction, dyslipidemia, improved prognosis, statins, ezetimibe For citation: Sedykh DYu, Fedorova NV, Kashtalap VV. Possibilities of combination lipid-lowering therapy in a patient with very high cardiovascular risk (сlinical case). Consilium Medicum. 2021; 23 (1): 70–73. DOI: 10.26442/20751753.2021.1.200604

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Treatment of Patients with Acute Coronary Syndrome with ST Segment Elevation in Clinical Practice of the Republic of Karelia: the Results of 10-year Register

Rational Pharmacotherapy in Cardiology ◽

10.20996/1819-6446-2020-10-14 ◽

2020 ◽

Vol 16 (5) ◽

pp. 780-786

Author(s):

I. S. Skopets ◽

N. N. Vezikova ◽

A. V. Malafeev ◽

A. N. Malygin ◽

V. A. Litvinova

Keyword(s):

Myocardial Infarction ◽

Clinical Practice ◽

Drug Therapy ◽

High Frequency ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment ◽

Optimal Drug ◽

The Republic ◽

Real Clinical Practice

Aim. To study the clinical course, treatment, and outcomes in the patients with ST segment elevation acute coronary syndrome (STeACS) in real clinical practiceMaterial and methods. Our study is based on data of 5694 patients who were sequentially hospitalized in the Regional Vascular Center from 01.01.2009 to 01.01.2019 due to STeACS and included in the Federal Hospital Register. Men prevailed (65.8%); the average age was 68 years old. 14.1% of the patients had the history of myocardial infarction (MI) before this hospitalization. The reperfusion strategy, drug therapy, as well as the risks of complications and outcomes in real clinical practice of the Republic of Karelia were analyzed. Descriptive statistics methods were used to evaluate the results.Results. In the study group a high frequency of reperfusion interventions (83.5%) with a predominance of percutaneous coronary intervention (PCI; 76.2%) was revealed, as well as optimal drug therapy in most patients. Thus, 99.4% of patients took aspirin, 82.8% – clopidogrel, 91.1% – anticoagulants, 91.6% – beta-blockers, 95.6% – statins, 94.2% – angiotensin-converting-enzyme inhibitors/angiotensin II receptors blockers. A risk assessment of hospital and 6-month mortality was performed using GRACE score. The distribution of the hospital risk mortality were the following: 25.7% of patients had a low (49-125 points), 33.7% an average (126-154 points), and 40.6% of patients had a high risk (more than 154 points). At the same time, the risk of 6-month mortality in a half of the patients (51.6%) was low (27-99 points), the average risk (100-127 points) was determined in 23.0% of patients and the high risk (more than 127 points) – in 25.5% of patients. Life threatening complications developed in 38.1% of patients and the most frequent ones were arrhythmias (31.5%). The outcomes at the discharge from the hospital were as follows: 1432 patients (63.5%) had Q MI, 390 (17.3%) – non Q MI, 76 (3.4%) – unstable angina, 21 (0.9%) – MI of unspecified localization and 317 patients (14.1%) – repeated myocardial infarction.Conclusion. According to the results of a 10-year hospital registry of patients with STeACS, a high frequency of reperfusion interventions and an optimal drug therapy in most patients was revealed. However, to increase the effectiveness of treatment, it is necessary to minimize temporary losses both at the prehospital treatment and during reperfusion.

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Consequences of escalation and de-escalation of double antiplatelet therapy in patients with acute coronary syndrome in real clinical practice

Russian Journal of Cardiology ◽

10.15829/1560-4071-2019-3-90-97 ◽

2019 ◽

Vol 24 (3) ◽

pp. 90-97

Author(s):

R. L. Shamraev ◽

O. V. Ilyukhin ◽

V. V. Ivanenko ◽

S. G. Merzlyakov ◽

Yu. M. Lopatin

Keyword(s):

Acute Coronary Syndrome ◽

Clinical Practice ◽

Conservative Treatment ◽

Antiplatelet Therapy ◽

Pain Syndrome ◽

P2y12 Inhibitor ◽

Treatment Switching ◽

Coronary Syndrome ◽

Clinical Consequences ◽

Real Clinical Practice

In recent years, the problem of P2Y12 inhibitor switching, called escalation and deescalation of double antiplatelet therapy (DAPT), in patients with acute coronary syndrome (ACS) has been the subject of active discussion.Aim.To assess the frequency and clinical consequences of transition from ticagrelor to clopidogrel and from clopidogrel to ticagrelor in real clinical practice in patients with ACS.Material and methods.Three hundred eight patients with ACS were included in the open, observational study. 121 patients (39,3%) receive conservative treatment, and 187 (60,7%) had invasive management tactics — percutaneous coronary interventions (PCI). In the group of conservative treatment switching from ticagrelor to clopidogrel and back was performed in 7 (5,8%) and 12 (9,9%) patients, respectively. In the second group switching from ticagrelor to clopidogrel and back were observed in 42 (34,7%) and 41 (33,9%) patients, respectively. Switching from one P2Y12 inhibitor to another occurred on 2-4 months from the beginning of therapy. The frequency of the following adverse events was chosen as the primary end point: death, re-infarction, re-hospitalization due to the development of chest pain syndrome, the need for coronary angiography or PCI.Results.In both groups of patients with ACS, the best survival was shown by patients who had an escalation of DAPT. In turn, during de-escalation, a significant decrease in survival cases was observed with the onset of one of the endpoint events (RR 2,88 with 95% CI 1,23-6,78; p<0,02).Conclusion.The study indicates a high frequency of de-escalation and escalation of DAPT, carried out in the outpatient management of patients undergoing ACS. There is a need of additional issue-related studies.

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EARLY OUTCOMES IN PATIENTS WITH SUSPECTED ACUTE CORONARY SYNDROME WITHOUT PERSISTENT ST ELEVATION, TRANSPORTED TO A VASCULAR CENTER BY AMBULANCE

Siberian Medical Journal ◽

10.29001/2073-8552-2018-33-4-143-147 ◽

2019 ◽

Vol 33 (4) ◽

pp. 143-147

Author(s):

A. A. Kharitonov ◽

O. A. Shtegman

Keyword(s):

Acute Coronary Syndrome ◽

Clinical Practice ◽

Clinical Examination ◽

Medical Records ◽

Telephone Survey ◽

Myocardial Necrosis ◽

Coronary Syndrome ◽

St Elevation ◽

Vascular Center ◽

Real Clinical Practice

The aimwas to study early outcomes in patients with suspected acute coronary syndrome without ST elevation who were transported by emergency to the vascular center.Material and Methods. We studied medical records from 396 patients with suspected acute coronary syndrome without ST elevation. A telephone survey of patients or their relatives was conducted within two months after the emergency call.Results. In-hospital diagnosis of acute coronary syndrome was confirmed only in 30.6% of patients with suspected acute coronary syndrome without ST elevation admitted to the vascular center. Cardiologists in the vascular center were ruling out diagnosis of acute coronary syndrome without ST elevation based on data of clinical examination and electrocardiography. During the following two months, 6.4% of the patients with ruled out diagnosis of acute coronary syndrome called emergency again; 2% of the patients were admitted with acute coronary syndrome to the vascular center; and 2.4% of the patients died at home.Conclusion. In real clinical practice, the assessment of myocardial necrosis biomarkers has been used not enough in cases of suspected acute coronary syndrome without ST elevation.

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