LIS-3 Acute Coronary Syndrome Registry: Changes in Clinical and Demographic Characteristics and Tactics of Prehospital and Hospital Treatment of Surviving Patients After Acute Coronary Syndrome Over a 4-Year Period

Abstract

Aim. To study the changes in clinical and demographic characteristics, risk factors, treatment tactics, the dynamics of drug therapy at the prehospital stage and prescribed during discharge from the cardiology department over a 4-year period in patients after acute coronary syndrome (ACS) with ST segment elevation and ACS without ST segment elevation. Material and methods. Data from the LIS-3 prospective registry (Lyubertsy mortality study) was used. Patients admitted to the cardiology department of the Lyubertsy district hospital No. 2 for the first 9 months of 2014 (n=104) and for the first 9 months of 2018 (n=223) with a diagnosis of “ACS with ST segment elevation and ACS without ST segment elevation” and with a confirmed diagnosis at discharge “acute myocardial infarction” (AMI) or “unstable angina” (NSA) were included into the study. Comparison of clinical and demographic indicators, risk factors, the frequency of use of acetylsalicylic acid, clopidogrel, statins, beta-blockers, ACE inhibitors, angiotensin II receptor antagonists, anticoagulants at the prehospital stage and during discharge from the hospital were performed. Results. Significant differences in the gender and age composition of patients were not found. The number of working patients increased. Compared to 2014, in 2018 the number of patients with arterial hypertension increased (64.4% and 75.8%, respectively, p=0.047), and with coronary heart disease decreased significantly (39.4% and 22.4%, respectively, p=0.004), however, the incidence of atrial fibrillation, history of AMI, and cerebral stroke did not change over the period under consideration. The frequency of concomitant diseases did not practically change, except for kidney diseases, which have become more common. A significant decrease in the frequency of thrombolysis and a significant (more than 6-fold) increase in angioplasty with stenting were found. Patients before ACS in 2014 received less antiplatelet agents than in 2018, including dual antiplatelet therapy, ACE inhibitors were prescribed more often. The intake of nitrates decreased, and the use of statins increased (6.7% versus 13.9%, respectively, p>0.05). AMI as the outcome of ACS was almost the same in both men and women. A downward trend in myocardial Q-infarction (p>0.05) was found. Taking dual antiplatelet therapy and ACE inhibitors were more often recommended at discharge and taking nitrates and any diuretics was less common. Statins intake did not change. Conclusion. The “portrait” of a hospitalized ACS patient changed somewhat over 4 years: the frequency of the history of coronary heart disease significantly decreased, and the frequency of hypertension increased. The presence and significance of risk factors such as hypercholesterolemia and adverse heredity cannot be assessed as before. The frequency of use of antiplatelet agents and statins increased in prehospital therapy; however, in general, a smaller proportion of patients requiring statins took them. The proportion of AMI patients among ACS ones did not change over the study period.