Use of antiplatelet agents in patients after myocardial infarction followed up in Moscow outpatient clinics. Results of a non-interventional prospective study

Aim. To assess the rate of adverse cardiovascular events (a combination of non-fatal myocardial infarction (MI), non-fatal stroke, cardiovascular death) within 12 months after MI in patients who were followed up in outpatient clinics in Moscow after the hospital discharge, as well as its association with antiplatelet therapy.

Material and methods. This observational multicenter, open-label, prospective study that consecutively included patients after MI and came for further treatment and observation to the clinic after the hospital discharge, subject to providing informed consent. Data were obtained at four scheduled visits (an inclusion visit and 3 follow-up visits — 3, 6 and 12 months after the event). An analysis was carried out in the context of various antiplatelet therapy.

Results. The study included 1576 patients in 27 Moscow clinics (mean age, 62,2±11,1 years; men — 69%; ST-segment elevation MI — 57,7%, non-ST elevation MI — 42,3%). At the time of study inclusion, 47,2% of patients received dual antiplatelet therapy with clopidogrel, 4,2% — prasugrel, 48,6% — ticagrelor, with a mean duration of 11,2 months. Incidence of adverse cardiovascular events over 12-month follow-up rate was low and amounted to 3,4% (cumulative incidence, 0,038). This indicator was significantly lower in the subgroup of patients who underwent percutaneous coronary intervention compared with patients who received conservative therapy for MI (p=0,0002).

Conclusion. The study demonstrated a low incidence of adverse cardiovascular events over 12 months in patients followed up in outpatient clinics in Moscow after an MI, while percutaneous coronary intervention for MI was associated with a lower incidence of adverse cardiovascular events compared with conservative therapy.

1. Russian Society of Cardiology (RSC). 2020 Clinical practice guidelines for Stable coronary artery disease. Russian Journal of Cardiology. 2020;25(11):4076. (In Russ.) doi:10.15829/29/1560-4071-2020-4076.

2. Bonaca MP, Braunwald E, Sabatine MS. Long-Term Use of Ticagrelor in Patients with Prior Myocardial Infarction. N Engl J Med. 2015;373(13):1274-5. doi:10.1056/NEJMc1508692.

3. Ehrlich AD. The first Moscow Registry of acute coronary syndrome: the results of a 6-month follow-up. Emergency cardiology. 2014;2:3-9. (In Russ.)

4. Zeymer U, Ludman P, Danchin N, et al.; ACVC EAPCI EORP ACS STEMI investigators group of the ESC. Reperfusion therapies and in-hospital outcomes for ST-elevation myocardial infarction in Europe: the ACVC-EAPCI EORP STEMI Registry of the European Society of Cardiology. Eur Heart J. 2021;42(44):4536-49. doi:10.1093/eurheartj/ehab342.

5. Boytsov SA, Alekyan BG, Shakhnovich RM, Ganyukov VI. What is changing in the treatment of acute coronary syndrome in the Russian Federation? Rational Pharmacotherapy in Cardiology. 2022;18(6):703-9. (In Russ.) doi:10.20996/1819-6446-2022-12-14.

6. Wallentin L, Becker RC, Budaj A, et al.; PLATO Investigators; Freij A, Thorsén M. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009; 361(11):1045-57. doi:10.1056/NEJMoa0904327.

7. Erlikh AD. Twelve months outcomes in patients with acute coronary syndrome, by the national registry RECORD-3. Russian Journal of Cardiology. 2018;(3):23-30. (In Russ.) doi:10.15829/1560-4071-2018-3-23-30.

8. Navarese EP, Khan SU, Kołodziejczak M, et al. Comparative Efficacy and Safety of Oral P2Y12 Inhibitors in Acute Coronary Syndrome: Network Meta-Analysis of 52 816 Patients From 12 Randomized Trials. Circulation. 2020;142(2):150-60. doi:10.1161/CIRCULATIONAHA.120.046786.

9. Barbarash OL, Duplyakov DV, Zateischikov DA, et al. 2020 Clinical practice guidelines for Acute coronary syndrome without ST segment elevation. Russian Journal of Cardiology. 2021;26(4):4449. (In Russ.) doi:10.15829/1560-4071-2021-4449.

10. Russian Society of Cardiology. 2020 Clinical practice guidelines for Acute ST-segment elevation myocardial infarction. Russian Journal of Cardiology. 2020;25(11):4103. (In Russ.) doi:10.15829/29/1560-4071-2020-4103.

11. Boytsov SA, Shakhnovich RM, Tereschenko SN, et al. Features of antiplatelet therapy with P2Y12 receptor inhibitors in patients with myocardial infarction according to the Rus­sian Register of Acute Myocardial Infarction REGION-MI. Kardiologiia. 2022;62(9):44-53. (In Russ.) doi:10.18087/cardio.2022.9.n2278.

12. Bradley SM, Hess GP, Stewart P, et al. Implications of the PEGASUS-TIMI 54 trial for US clinical practice. Open Heart. 2017;4:e000580. doi:10.1136/openhrt-2016-000580.

13. Ferlini M, Rossini R, Musumeci G, et al. Dual antiplatelet therapy prolongation in high-risk patients with prior myocardial infarction: insights from the post-PCI registry. J Cardiovasc Med (Hagerstown). 2020;21(8):603-9. doi:10.2459/JCM.0000000000000988.