The Advantages of Dual Antiplatelet Therapy Combinations in Predicting Recurrent Cardiovascular Events in Obese Patients after Myocardial Infarction

Abstract

The purpose of the study was to analyze the incidence of recurrent cardiovascular events in obese patients after a myocardial infarction during a 6-month follow-up period, depending on the combination of ticagrelor or clopidogrel with acetylsalicylic acid as a part of dual antiplatelet therapy. Materials and methods. The study involved 75 patients with acute myocardial infarction with ST segment elevation and concomitant obesity. The patients were divided into 2 subgroups: the first included 31 patients who received the combination of acetylsalicylic acid and ticaglelor, and the second – 44 patients treated with the combination of acetylsalicylic acid and clopidogrel in dual antiplatelet therapy. The GRACE scale was used to stratify the risk of hospital and 6-month mortality. Control of the recurrent cardiovascular events presence was carried out after 6 months. Results and discussion. Acute myocardial infarction with ST elevation is still the main cause of mortality and invalidisation of able-bodied population. Regardless of the primary percutaneous coronary intervention or thrombolysis, dual antiplatelet therapy remains the main therapeutic strategy, both in the acute ST-elevation myocardial infarction period and in the remote – for the secondary prevention of possible adverse cardiovascular events, and is a combination of acetylsalicylic acid and a P2Y12 receptor inhibitor. To date, the issue of the choice of a P2Y12 receptor inhibitor in the dual antiplatelet therapy that is used in the treatment of ST-elevation myocardial infarction is an urgent subject of scientific discussion. While observing patients after a myocardial infarction with concomitant obesity over a period of 6 months, it was found that 28 patients had a recurrent myocardial infarction and / or unstable angina, which was 37.56% of all patients. The analysis of the GRACE scale scores in a cohort of patients with recurrent cardiovascular events revealed that all patients were included in high risk group (> 118 points). In the group of patients who received dual antiplatelet therapy with the involvement of acetylsalicylic acid and ticagrelor in 11 people recorded a repeated myocardial infarction and / or unstable angina, which was 14.76%. At the same time, in a group of patients receiving dual antiplatelet therapy in a combination of acetylsalicylic acid with clopidogrel, re-cardiovascular catastrophes were detected in 17 patients, which was 22.8% of all patients with ST-elevation myocardial infarction on the background of concomitant obesity. Conclusion. The patients with obesity after a myocardial infarction who are included in the GRACE high risk group are recommended to be treated with the combination of acetylsalicylic acid and ticagrelor as a result of a notable reduction in the risk of recurrent cardiovascular catastrophes compared with the combination of acetylsalicylic acid and clopidogrel