Medicamentous therapy of stable coronary artery disease sensu the guidelines on myocardial revascularization

Abstract

Objective: based on the Russian Federation multicenter registry data, to assess the comprehensiveness of medicamentous therapy in patients with stable coronary artery disease (CAD) from the perspective of 2018 European Society of Cardiology (ESC-2018) recommendations for myocardial revascularization and 2017 American Appropriate Use Criteria (AUC-2017) for the expediency of revascularization. Materials and methods. Anamnestic data of 1531 patients with stable CAD (average age: 61.7 ± 9.8 years; 76% men) were studied. The data source was the Russian Federation multicenter registry of patients with arterial hypertension, CAD, and chronic heart failure. We identified the prescription of optimal medical therapy (OMT) sensu ESC-2018, maximal anti-ischemic therapy (MAT) sensu AUC-2017, and compliance of drug therapy with ESC-2018 and AUC-2017 simultaneously. OMT included at least one anti-ischemic medication + antiplatelet agent + statin + short-acting nitrate + blocker of the renin-angiotensin system in the presence of hypertension, diabetes mellitus, or heart failure. MAT included at least two anti-ischemic pharmaceutical drugs. Compliance with these criteria was determined in the groups of patients who underwent, or did not undergo, myocardial revascularization, as well as among those, for whom invasive treatment was indicated as the first priority, as the second priority, or was not indicated at all, according to ESC-2018 and AUC-2017. Results. Among patients who received solely medicamentous therapy (n=924), OMT was prescribed in 18%, while in the revascularization group (n= 07), in 9% of cases (p <0.001). MAT was also prescribed more often in the conservative therapy group (34%) than in the revascularization group (24%): p = 0.001. OMT sensu ESC-2018 and AUC-2017 in the groups with, or without, intervention was prescribed in 3% vs. 7% of cases, respectively (p <0.001). Conclusion. According to the Russian Federation multicenter registry, medicamentous therapy of stable CAD complies with the provisions of European and American clinical guidelines for myocardial revascularization in a small proportion of patients, regardless of the chosen treatment tactics.

Pretest probability of coronary artery disease as a factor for optimizing invasive diagnostics in routine clinical practice

“…Данное наблюдение демонстрирует, что в целом у врачей не складывается четкого представления о необходимости тех или иных вмешательств, что влечет за собой как нецелевое расходование средств и ресурсов здравоохранения для проведения сложных вмешательств, так и несоблюдение баланса риска вмешательства и клинической пользы для пациента. Кроме этого, ранее было показано, что при адекватном медикаментозном лечении возможно избежать интракоронарных вмешательств [13], что еще раз подчеркивает важность своевременного определения величины ПТВ и решения вопроса о целесообразности применения высокотехнологичных методик диагностики и лечения. Следовательно, врачам рекомендуется более внимательно относиться к определению ПТВ у пациентов с болью в груди при выборе диагностической стратегии.…”