Coronary Artery Disease with a High Risk of Complications: How to Identify Such Patients and Choose Management Tactics?

Abstract

Patients with diagnosed coronary artery disease and/or peripheral arterial disease have a high risk of cardiovascular death and disabling vascular events, including stroke, myocardial infarction, and amputation. Secondary prevention in these high-risk patients should include control of modifiable risk factors for the progression of atherosclerosis and antithrombotic therapy to prevent atherothrombosis. Analysis of the literature from the databases PubMed, MEDLINE, HighWire Press was carried out to determine the modern possibilities of assessing the risk of ischemic and hemorrhagic events in a stable course of cardiovascular diseases caused by atherosclerosis, which can be used to determine the categories of patients with the greatest potential benefit from combination antithrombotic therapy. The results of a large randomized study COMPASS, their sub-analyses and the work of other authors, published over the last year, allow us to formulate reasonable conclusions that facilitate the adoption of medical decisions when choosing treatment tactics for patients with a stable course of atherosclerotic cardiovascular diseases. When using low doses of rivaroxaban and aspirin in high-risk groups, the rate of adverse events, including cardiovascular death, myocardial infarction, stroke, and vascular complications of peripheral artery disease, can be significantly reduced. High-risk criteria for severe cardiovascular complications are multifocal atherosclerotic lesions, heart failure, myocardial infarction, diabetes mellitus, or chronic kidney disease. Patients with the highest risk of vascular events will receive the greatest absolute benefit from this treatment. Secondary prevention in patients with chronic coronary syndromes, sinus rhythm and a moderate risk of cardiovascular complications using low doses of rivaroxaban and aspirin is justified, since the ratio of its risk and benefit remains favorable.