Abstract

Aim.We aimed to study in real clinical practice the clinical and anamnestic characteristics, the peculiarities of double antiplatelet therapy (DAPT) prescription as well the incidence of ischemic and hemorrhagic events in patients with ST-elevated myocardial infarction (MI) during a year of follow-up, taking into account the baseline PRECISE-DAPT scores.Material and methods.The study included 680 patients with MI from the database of Kemerovo observational registry for acute coronary syndrome (ACS). All the patients retrospectively underwent an individual calculation using the PRECISE-DAPT score. Then, depending on the number of the points, all the patients were divided into the low (less than 25 points) and high (25 or more points) risks groups. Differences in clinical and anamnestic parameters, the peculiarities of DAPT prescription, as well as the incidence of ischemic and hemorrhagic outcomes during a year of follow-up after MI were estimated in the groups.Results.The Russian patients with ST-elevated MI and the high PRECISE-DAPT hemorrhagic risk score had a history of renal pathology (р=0.010), multivessel coronary artery disease and polyvascular disease (р=0.002), prior angina pectoris (р=0.001), as well as the course of the index event with the manifestations of acute coronary failure (р=0.001) more often than the patients from the low-risk group. The patients of the high-risk group less often underwent coronary angiography with stenting (р=0.001), as well as coronary artery bypass grafting (р=0.010) at hospitalization and had a higher in-hospital mortality rate (р=0.002). The patients at high hemorrhagic risk according to the PRECISE-DAPT score were less often prescribed with DAPT within a year after MI (р=0.001) and aspirin monotherapy was preferred more often (р=0.001). At the same time, the patients at high hemorrhagic risk on the PRECISE-DAPT score had more often major bleedings, recurrent MI and deaths (р=0.001) within a year after MI.Conclusion.In the present study, the possibilities of risk assessment with the PRECISE-DAPT score were retrospectively tested on the sample of patients with MI from the ACS registry in Kemerovo city. Good identification of patients with the high risks of hemorrhagic events and ischemic outcomes within 12 months of the follow-up after index MI has been shown, which allows to recommend the PRECISE-DAPT score for a clinical practice in order to rationalize the approaches to DAPT prescription and to optimize the existing approaches to the comprehensive risk assessment of patients with ACS along with existing scales.

Highlights

  • Кемерово ретроспективно апробированы возможности рискометрии с помощью шкалы PRECISE-double antiplatelet therapy (DAPT): показана хорошая идентификация пациентов с высокими рисками геморрагических событий, а также ишемических исходов на протяжении 12 мес наблюдения после индексного инфарктом миокарда (ИМ), что позволяет рекомендовать ее для применения в клинической практике с целью рационализации подходов к назначению двойной антитромбоцитарной терапии (ДАТТ) и оптимизации существующих подходов к комплексной оценке риска пациентов с острого коронарного синдрома (ОКС) наряду с существующими шкалами

  • We aimed to study in real clinical practice the clinical and anamnestic characteristics, the peculiarities of double antiplatelet therapy (DAPT) prescription as well the incidence of ischemic and hemorrhagic events in patients with ST-elevated myocardial infarction (MI) during a year of follow-up, taking into account the baseline PRECISE-DAPT scores

  • The possibilities of risk assessment with the PRECISE-DAPT score were retrospectively tested on the sample of patients with MI from the acute coronary syndrome (ACS) registry in Kemerovo city

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Summary

Conclusion

The possibilities of risk assessment with the PRECISE-DAPT score were retrospectively tested on the sample of patients with MI from the ACS registry in Kemerovo city. Одним из объяснений осторожного отношения отечественных кардиологов к имеющимся шкалам оценки риска ишемических/геморрагических событий является отсутствие оценки их возможностей у пациентов с ОКС в условиях российской популяции. Таким образом в связи с необходимостью клинической апробации прогностических возможностей шкалы PRECISE-DAPT на когорте российских пациентов с ОКС целью настоящего исследования было изучить в условиях реальной клинической практики клинико-анамнестические характеристики, особенности назначения ДАТТ, а также частоту развития ишемических и геморрагических исходов у пациентов с перенесенными инфарктом миокарда (ИМ) с подъемом сегмента ST в течение года наблюдения с учетом исходной суммы баллов по шкале PRECISE-DAPT

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