ANALYSIS OF OUTPATIENT PHYSICIANS, PRESCRIPTION OF DISAGGREGANT THERAPY FOR PATIENTS AFTER ACUTE MYOCARDIAL INFARCTION AND/OR CORONARY ANGIOPLASTY WITH STENT IMPLANTATION WITHIN THE RECVAD REGISTRY
https://doi.org/10.17650/1818-8338-2015-9-3-34-39
Abstract
Objective: to estimate the quality of antiaggregants therapy in patients with coronary heart disease in outpatient settings.
Materials and methods. The data of the retrospective outpatient RECVAD registry (3690 patients who lived in Ryazan and its Region and had evidence in their outpatient medical records for one of the diagnoses, such as coronary heart disease, hypertension, chronic heart failure, atrial fibrillation, or their concurrence, were used. Fortynine patients after acute myocardial infarction (AMI) and/or percutaneous coro nary interventions (PCI) with stenting ≤ 1 year before their inclusion in the registry, who were to undergo dual antiaggregant therapy (DAT) according to current clinical guidelines (CG), were identified among 427 patients after AMI and/or PCI with coronary angioplasty. Contra indications to DAT were simultaneously revealed and a relationship of the use of therapy to their presence was compared.
Results. Among the 49 patients who had indications for DAT that was used in 15 (30.6 %) cases and that was not in 3 (6.1 %) patients in the presence of contraindications, 25 (51.0 %) did not receive DAT in the absence of contraindications and 6 (12.3 %) patients received the therapy in the presence of contraindications.
Conclusion. DAT prescribed by outpatient physicians does not always meet the current CG. There are cases of not using DAT in the presence of obvious indications for DAT and, on the contrary, those of its use in the presence of contraindications.
Keywords
About the Authors
A. V. ZagrebelnyiRussian Federation
S. Yu. Martsevich
Russian Federation
M. M. Lukyanov
Russian Federation
E. G. Pereverzeva
Russian Federation
A. N. Vorobyev
Russian Federation
S. S. Yakushin
Russian Federation
S. A. Boitsov
Russian Federation
References
1. Грацианский Н.А., Оганов Р.Г., Агапов А.А. и др. Национальные рекомендации по лечению острого коронарного синдрома без стойкого подъема ST на ЭКГ. Кардиоваскулярная терапия и профилактика 2006;8(5):1–32. [Gratsianskiy N.A., Oganov R.G., Agapov A.A. et al. National recommendations for treatment of acute coronary syndromes without persistent increase in the ST segment of the ECG. Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular Therapy and Prevention 2006;8 (5):1–32. (In Russ.)].
2. Руда М.Я., Голицын С.П., Грацианский Н.А. и др. Национальные рекомендации по диагностике и лечению больных острым инфарктом миокарда с подъемом сегмента ST ЭКГ. Кардиоваскулярная терапия и профилактика 2007;6(8):1–146. [Ruda M.Ya., Golitsyn S.P., Gratsianskiy N.A. et al. National recommendations for diagnostics and treatment of patients with acute myocardial infarction with increase in the ST segment of the ECG. Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular therapy and prevention 2007;6(8):1–146. (In Russ.)].
3. Акчурин Р.С., Васюк Ю.А., Карпов Ю.А. и др. Национальные рекомендации по диагностике и лечению стабильной стенокардии. Кардиоваскулярная терапия и профилактика 2008;7(6):1–37. [Akchurin R.S., Vasyuk Yu.A., Karpov Yu.A. et al. National recommendations for diagnostics and treatment of stable angina. Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular therapy and prevention 2008;7(6):1–37. (In Russ.)].
4. Authors/Task Force members, Windecker S., Kolh P. et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2014;35(37):2541–619.
5. Hamm C.W., Bassand J.P., Agewall S. et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2011;32(23): 2999–3054.
6. Task Force on the management of STsegment elevation acute myocardial infarction of the European Society of Cardiology (ESC), Steg P.G., James S.K. et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012;33 (20):2569–619.
7. American College of Emergency Physicians; Society for Cardiovascular Angiography and Interventions, O,Gara P.T., Kushner F.G. et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/ American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013;61(4):485–510.
8. Anderson J.L., Adams C.D., Antman E.M. et al. 2011 ACCF/AHA focused update incorporated into the ACC/AHA 2007 Guideline for the Management of patients with unstable angina/non-ST-elevation myocardial infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011;123(18):e426–579.
9. Марцевич С.Ю., Кутишенко Н.П., Гинзбург М.Л. и др. Антиагрегантная терапия у больных с высоким риском развития тромботических осложнений: проблема эффективности, безопасности и приверженности. Клиницист 2011;(2):72–9. [Martsevich S.Yu., Kutishenko N.P., Ginzburg M.L. et al. Antiplatelet therapy of patients at high risk of thrombotic complications: the problem of efficiency, safety, and commitment. Klinitsist = Clinician 2011;(2):72–9. (In Russ.)].
10. Марцевич С.Ю., Гинзбург М.Л., Малышева A.M. и др. Современная терапия антиагрегантами больных ишемической болезнью сердца с высоким риском тромботических осложнений. Данные доказательной медицины и реальная практика. Рациональная фармакотерапия в кардиологии 2011;7(3):319–22. [Martsevich S.Yu., Ginzburg M.L., Malysheva A.M. et al. Modern therapy of patients with ischemic heart disease at high risk of thrombotic complications with antiplatelet drugs. Evidence-based medicine data and actual practice. Ratsionalnaya farmakoterapiya v kardiologii = Rational pharmacotherapy in cardiology 2011;7(3):319–22. (In Russ.)].
11. Марцевич С.Ю., Воронина В.П., Гинзбург М.Л. и др. Современная терапия антиагрегантами больных с высоким риском тромбообразования и реальная клиническая практика. Рациональная фармакотерапия в кардиологии 2012;8(2):163–7. [Martsevich S.Yu., Voronina V.P., Ginzburg M.L. et al. Modern therapy of patients at high risk of thrombogenesis with antiplatelet drugs and actual clinical practice. Ratsionalnaya Farmakoterapiya v Kardiologii = Rational Pharmacotherapy in Cardiology 2012;8(2):163–7. (In Russ.)].
12. Марцевич С.Ю., Гинзбург М.Л., Кутишенко Н.П. и др. Динамика догоспитальной терапии больных с острым коронарным синдромом с 2005 по 2014 гг. по данным регистра ЛИС. Рациональная фармакотерапия в кардиологии 2014;10(6):631–3. [Martsevich S.Yu., Ginzburg M.L., Kurishenko N.P. et al. Diagnostics of pre-hospital therapy of patients with acute coronary syndrome from 2005 to 2014 according to the data in the LIS register. Ratsionalnaya Farmakoterapiya v Kardiologii = Rational Pharmacotherapy in Cardiology 2014;10(6):631–3. (In Russ.)].
13. Гусева Г.Н., Павлова Т.В., Воронова И.Л., Хохлунов С.М. Двойная антитромбоцитарная терапия в реальной клинической практике. Рациональная фармакотерапия в кардиологии 2014;10(5):500–4. [Guseva G.N., Pavlova T.V., Voronova I.L., Khokhlunov S.M. Dual antiplatelet therapy in actual clinical practice. Ratsionalnaya farmakoterapiya v kardiologii = Rational pharmacotherapy in cardiology 2014;10(5):500–4. (In Russ.)].
14. Бойцов С.А., Якушин C.С., Марцевич С.Ю. и др. Амбулаторно-поликлинический регистр кардиоваскулярных заболеваний в Рязанской области (РЕКВАЗА): основные задачи, опыт создания и первые результаты. Рациональная фармакотерапия в кардиологии 2013;9(1):4–14. [Boytsov S.A., Yakushin S.S., Martsevich S.Yu. et al. In-patient and outpatient register of cardiovascular diseases in Ryazan Region (REKVAZA): major tasks, formation experience, and first outcomes. Ratsionalnaya farmakoterapiya v kardiologii = Rational pharmacotherapy in cardiology 2013;9(1):4–14. (In Russ.)].
15. Бойцов С.А., Лукьянов М.М., Якушин С.С. и др. Регистр кардиоваскулярных заболеваний (РЕКВАЗА): диагностика, сочетанная сердечно-сосудистая патология, сопутствующие заболевания и лечение в условиях реальной амбулаторно-поликлинической практики. Кардиоваскулярная терапия и профилактика 2014;13(6):44–50. [Boytsov S.A., Lukiyanov M.M., Yakushin S.S. et al. Register of cardiovascular diseases (REKVAZA): diagnostics, concomitant cardiovascular pathology, comorbidity and treatment in conditions of actual in-patient and out-patient Practice. Kardiovaskulyarnaya Terapiya i Profilaktika = Cardiovascular Therapy and Prevention 2014;13(6):44–50. (In Russ.)].
16. Bhatt D.L., Scheiman J., Abraham N.S. et al. ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. Circulation 2008;118(18):1894–909.
17. Abraham N.S., Hlatky M.A., Antman E.M. et al. ACCF/ACG/AHA 2010 Expert Consensus Document on the concomitant use of proton pump inhibitors and thienopyridines: a focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. Circulation 2010;122(24): 2619–33.
18. Steinhubl S.R., Berger P.B., Mann J.T. et al. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial. JAMA 2002;288(19):2411–20.
Review
For citations:
Zagrebelnyi A.V., Martsevich S.Yu., Lukyanov M.M., Pereverzeva E.G., Vorobyev A.N., Yakushin S.S., Boitsov S.A. ANALYSIS OF OUTPATIENT PHYSICIANS, PRESCRIPTION OF DISAGGREGANT THERAPY FOR PATIENTS AFTER ACUTE MYOCARDIAL INFARCTION AND/OR CORONARY ANGIOPLASTY WITH STENT IMPLANTATION WITHIN THE RECVAD REGISTRY. The Clinician. 2015;9(3):34-39. (In Russ.) https://doi.org/10.17650/1818-8338-2015-9-3-34-39