Guideline‐Recommended Therapies and Clinical Outcomes According to the Risk for Recurrent Cardiovascular Events After an Acute Coronary Syndrome

Abstract

BackgroundPatients who have had an acute coronary syndrome (ACS) are at increased risk of recurrent cardiovascular events; however, paradoxically, high‐risk patients who may derive the greatest benefit from guideline‐recommended therapies are often undertreated. The aim of our study was to examine the management, clinical outcomes, and temporal trends of patients after ACS stratified by the Thrombolysis in Myocardial Infarction (TIMI) risk score for secondary prevention, a recently validated clinical tool that incorporates 9 clinical risk factors.Methods and ResultsIncluded were patients with ACS enrolled in the biennial Acute Coronary Syndrome Israeli Surveys (ACSIS) between 2008 and 2016. Patients were stratified by the TIMI risk score for secondary prevention to low (score 0–1), intermediate (2), or high (≥3) risk. Clinical outcomes included 30‐day major adverse cardiac events (death, myocardial infarction, stroke, unstable angina, stent thrombosis, urgent revascularization) and 1‐year mortality. Of 6827 ACS patients enrolled, 35% were low risk, 27% were intermediate risk, and 38% were high risk. Compared with the other risk groups, high‐risk patients were older, were more commonly female, and had more renal dysfunction and heart failure (P<0.001 for each). High‐risk patients were treated less commonly with guideline‐recommended therapies during hospitalization (percutaneous coronary intervention) and at discharge (statins, dual‐antiplatelet therapy, cardiac rehabilitation). Overall, high‐risk patients had higher rates of 30‐day major adverse cardiac events (7.2% low, 8.2% intermediate, and 15.1% high risk; P<0.001) and 1‐year mortality (1.9%, 4.6%, and 15.8%, respectively; P<0.001). Over the past decade, utilization of guideline‐recommended therapies has increased among all risk groups; however, the rate of 30‐day major adverse cardiac events has significantly decreased among patients at high risk but not among patients at low and intermediate risk. Similarly, the 1‐year mortality rate has decreased numerically only among high‐risk patients.ConclusionsDespite an improvement in the management of high‐risk ACS patients, they are still undertreated with guideline‐recommended therapies. Nevertheless, the outcome of high‐risk patients after ACS has significantly improved in the past decade, thus they should not be denied these therapies.

Assessment of the effectiveness of treatment in patients after acute coronary syndrome

“…При повторном исследовании больных измерялся уровень артериального давления (АД) и частоты сердечных сокращений (ЧСС), определялись уровни общего холестерина (ОХ) и холестерина липопротеидов низкой плотности (ХСЛНП) точностью (ХСН) [5,9]. 1 группу составили 151 больных осложнённого течения ИБС, 2 группу -249 больных стабильного течения ИБС (рис.…”

“…За последние десятилетия сердечно-сосудистая смертность во всех промышленно развитых странах неуклонно снижается. Неоспоримую положительную роль сыграли мероприятия первичной и вторичной профилактики атеросклероза [1][2][3][4][5]. Существенным фактором улучшения прогноза явилось внедрение интервенционного направления лечения больных с острым коронарным синдромом (ОКС).…”

“…Усилиями исследователей последних десятилетий удалось создать концепцию доказательной медицины. Строго научный подход позволил обоснованно внедрить в клиническую практику многочисленные лечебные стратегии и фармакологические группы препаратов, улучшающие прогноз больных с ИБС [4,5]. Как показывают данные исследований, любые возможности профилактики теряют свои позиции при низких социально-экономических условиях жизни людей.…”

Peculiarities of Platelet Metabolism in Patients with Acute Coronary Syndrome with Anxiety–Depressive Disorders and Informativity of Enzymes in the Forecast of Development of Cardiovascular Complications

“…Despite the optimal medical help during the first 30 days of hospitalization after ACS, the risk of unfavorable cardiovascular occurrences is at its highest. However, later on the patients who have had ACS are still subject to a continuous higher risk of recurrent cardiovascular incidents [ 11 , 12 ].…”

Early Recovery of Left Ventricular Function After Revascularization in Acute Coronary Syndrome

“…Acute coronary syndrome (ACS) remains a major cause of death and morbidity worldwide [1], despite the well-established treatment strategies including direct revascularization with percutaneous coronary intervention (PCI) [2]. The recent significant improvement in PCI is related to the implantation of various types of drug-eluting stents and the use of dual antiplatelet therapies; however, patients with ACS still have a higher risk for cardiovascular events compared to those with no acute events [3].…”