THE ANALYSIS OF LONG-TERM OUTCOMES AND ADHERENT TO TREATMENT IN PATIENTS AFTER MYOCARDIAL INFARCTION: KHABAROVSK REGISTER DATA

Objective. To evaluate the long-term outcomes and medical treatment in patients during 2.5 years after reference acute myocardial infarction (AMI), to study adherent to medical treatment and the role of various factors affecting the long-term prognosis.

Materials and methods. The AMI Register included data about all patients, whom are consistently hospitalized in the regional vascular center (RVC) of Khabarovsk during the period from 01.01.14 till 31.03.14. The 2.5 years outcomes and adherence to treatment were evaluated by using phone interview.

Results. According to prospective part of the AMI Register of 292 patients discharged from the regional vascular center (RVC), the vital status in 2.5 years managed to be established at 274 (93.8 %) from which died 45 (16.42 %, or 15.40 % from all discharged patients). In structure of a mortality the proportion of dead from cardiovascular disease (СVD) patients made 86.6 %. The long-term mortality of patients with myocardial infarction with ST-segment elevation was 19.3 %, the myocardial infarction non-ST-segment elevation – 13.2 %; р = 0.632.

The new predictors of death 2.5 years after the onset of AMI were cerebrovascular diseases, the absence of the antihypertensive drugs and β-blockers before reference AMI, not prescribing antiplatelet drugs in loading doses in the early hours of the disease. Frequency of real reception of statins was 65.1 %, angiotensin-renin blockers –76.0  %, β-blocker – 73.8 % of patients after AMI. Only 55.9 % patients Received double antithrombocytic therapy (DATT)  during a year. By  the Moriscors–Green test adherent were only 109 (47.6 %). 79 (34.5 %) know their values cholesterol, blood pressure and blood glucose.

Conclusions. Indicators of the remote lethality among patients authentically didn’t differ with a myocardial infarction with ST-segment elevation in AMI and a myocardial infarction non-ST-segment elevation in AMI in the remote period. The register AMI taped failure predictors, showed the insufficient frequency of reception of recommended medicinal drugs in secondary prophylaxis after a referent AMI, especially concerning statines and DATT.  The  commitment of patients of long medicamental therapy, and also awareness on indicators of quality of treatment (level of a cholesterin, blood pressure) in real clinical practice according to the register were low.

1. Go A.S., Mozaffarian D., Roger V.L. et al. Heart disease and stroke statistics-2014 update: a report from the American Heart Association. Circulation 2014;129(3): e28–e292. DOI: 10.1161/01.cir.0000441139.02102.80.

2. Erlikh A.D., Matskeplishvili S.T., Gratsianskiy N.A. Buziashvili Yu.I. the First Moscow register of acute coronary syndrome: characteristics of patients, treatment and outcome during the hospital stay. Kardiologiya = Cardiology 2013;53(12):4–13. (In Russ.).

3. Erlikh A.D., Gratsianskiy N.A. Russian registry of acute coronary syndromes “RECORD-3”. Characteristics of patients and treatment before discharge from the hospital. Kardiologiya = Cardiology 2016;56(4):16–24. (In Russ.).

4. Vasil’eva L.V., Shevchenko I.I., Ehrlich A.D. et al. The dynamics of treatment and in-hospital outcomes in patients with acute coronary syndrome in the “non-invasive” hospitals (register data series “RECORD”). Trudnyy patsient = Difficult Patient 2016;14(1):5–10. (In Russ.).

5. Ginzburg M.L., Martsevich S.Yu., Kutishenko N.P. et al. The possibility of register as a quality control tool of pharmacotherapy at outpatient treatment in patients with high risk of cardiovascular complications (REGISTER “LIS-1”). Ratsional’naya farmakoterapiya v kardiologii = Rational Pharmacotherapy in Cardiology 2014;10(3):288–92. (In Russ.).

6. Prevention of chronic non-communicable diseases. Recommendations. Moscow, 2013. Available at: http://cardio-69.ru/sites/default/files/profilaktika_hronicheskih_neinfekcionnyh_zabolevaniy._rekomendacii_gnicpm._chuchalin_a.g._boycov_s.a.pdf. (In Russ.).

7. Perk J., De Backer G., Gohlke H. et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J 2012;33(13):1635–701. DOI: 10.1093/eurheartj/ehs092.

8. 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 coronary syndromes in patients presenting with ST-segment elevation. Eur Heart J 2012;33(20):2569–619.

9. Roffi M., Patrono C., Collet J.P. et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 2016;37(3):267–315. DOI: 10.1093/eurheartj/ehv320.

10. Kotseva K., Wood D., De Bacquer D. et al. EUROASPIRE IV: A European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries. Eur J Prev Cardiol 2016;23(6):636–48. DOI: 10.1177/2047487315569401.

11. Martsevich S.Yu., Ginzburg M.L., Kutishenko N.P. et al. Lyubertsy study on mortality (study LIS): factors affecting long-term prognosis of life after myocardial infarction. Profilakticheskaya maditsina = Preventive Medicine 2013;16(2):32–8. (In Russ.).

12. Erlikh A.D. First Moscow register of acute coronary syndrome: results of a 6-month observation. Neotlozhnaya kardiologiya = Emergency Cardiology 2014;(2):3–9. (In Russ.).

13. Goldberg R.J., Currie K., White K. et al. Six-month outcomes in a multinational registry of patients hospitalized with an acute coronary syndrome (the Global Registry of Acute Coronary Events [GRACE]). Am J Cardiol 2004;93(3):288–93. DOI: 10.1016/j.amjcard.2003.10.006. PMID: 14759376.

14. Pocock S., Bueno H., Licour M. et al. Predictors of one-year mortality at hospital discharge after acute coronary syndromes: A new risk score from the EPICOR (long-tErm follow uP of antithrombotic management patterns In acute CORonary syndrome patients) study. Eur Heart J 2015;4(6):509–17. DOI: 10.1177/2048872614554198.

15. Malay L.N., Solokhina L.V., Bukhonkina Yu.M. et al. Characteristics of patients and hospital outcomes in patients with acute myocardial infarction: data register (Khabarovsk). Part 1. Ratsional’naya farmakoterapiya v kardiologii = Rational Pharmacotherapy in Cardiology 2016;12(1):56–62. (In Russ.).

16. Morinsky D.E., Green L.W., Levine D.M. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 1986;24(1):67–74. PMID: 3945130.

17. Barbarash O.L., Kashtalap V.V. Treatment of patients with acute coronary syndrome without STsegment elevation. All problems solved? Serdtse = Heart 2016;15(5):320–5. (In Russ.).

18. Montalescot G., Dallongeville J., Van Belle E. et al. STEMI and NSTEMI: are they so different? 1 year outcomes in acute myocardial infarction as defined by the ESC/ACC definition (the OPERA registry). Eur Heart 2007;28(12):1409-17. DOI: 10.1093/eurheartj/ehm031.

19. Collinson J., Flather M.D., Fox K.A. at al. Clinical outcomes, risk stratification and practice patterns of unstable angine and myocardial infarction without ST elevation: Prospective Registry of Acute Ischaemic Syndrom in the UK (PRAUS-UK). Eur Heart J 2000;21(17):1450–7. DOI: 10.1053/euhj.1999.1995.

20. Cox D.A., Stone G.W., Grines C.L. et al. Comparative early and late outcomes after primary percutaneous coronary intervention in ST-segment elevation and nonST-segment elevation acute myocardial infarction (from CADILLAC trial). Am J Cardiol 2006;98(3):331–7. DOI:10.1016/j.amjcard.2006.01.102. PMID: 16860018.

21. Martsevich S.Yu., Kutishenko N.P. Ginzburg M.L. et al. Influence of atrial fibrillation on the nearest and remote forecast of life in acute myocardial infarction. These studies LIS-1 (Lyubertsy study of mortality of patients with acute myocardial infarction). Ratsional’naya farmakoterapiya v kardiologii = Rational Pharmacotherapy in Cardiology 2014:10(2):170–3. (In Russ.).

22. Pogosova N.V. Oganov R.G., Boytsov S.A. et al. Drug therapy in patients with coronary heart disease in Russia and Europe: results from the Russian part of the international multicenter study EUROASPIREIV. Kardiologiya = Cardiology 2016;56(12):11–9. (In Russ.).

23. Ferreira-Gonzales I., Marsal J.R., Ribera A. et al. Background, incidence, and predictors of antiplatelet therapy discontinuation during the first year after drug-eluting stent implantation. Circulation 2010;122(10):1017–25. DOI: 10.1161/CIRCULATIONAHA.110.938290.

24. Kherada N., Sartori S., Vadde R. et al. Predictors of dual antiplatelet therapy non-adherence after PCI: one-year insights from the PARIS Registry. JACC 2013;61(10):E151. DOI: 10.1016/j.jacc.2012.08.1037.

25. Erlikh A.D., Gratsianskiy N.A. The use of antithrombotic drugs in acute coronary syndrome in daily clinical practice of Russian hospitals (according to register “RECORD-3”). Aterotromboz = Atherothrombosis 2016;(2):27–35. (In Russ.).

26. Osterberg L., Blaschke T. Adherence to Medication. N Engl J Med 2005;353(5):487–97. DOI: 10.1056/NEJMra050100.

27. Gilyarevskiy S.R. Adherence to the prescribed therapy regimen and the effectiveness of treatment of patients with chronic coronary heart disease: state of the problem and its solutions. Serdtse = Heart;15(6):391–7. (In Russ.).

28. Jackevicius C.A., Li P., Tu J.V. Prevalence, predictors and outcomes of primary nonadherence after acute myocardial infarction. Circulation 2008;117(8): 1028–36. DOI: 10.1161/CIRCULATIONAHA.107.706820.