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Patients with History of Myocardial Infarction and Acute Cerebrovascular Accidentin Clinical Practice: Demographic, Clinical Characteristics, Drug Treatment and Outcomes (Data of Outpatient and Hospital Registry REGION)

https://doi.org/10.20996/1819-6446-2019-15-5-656-662

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Abstract

Aim. To assess the demographic and clinical characteristics, drug treatment and outcomes in patients with a history of acute cerebrovascular accident (ACVA) and with concomitant history of myocardial infarction (MI) in clinical practice based on outpatient and hospital parts of REGION registry.

Material and methods. The total 1886 patients with a history of ACVA (aged of 70.6±12.5 years, 41.9% men) were enrolled into the outpatient registry REGION (Ryazan) and the hospital registry REGION (Moscow). 356 patients had ACVA and a history of MI (group “ACVA+MI” and 1530 patients had ACVA without history of MI (group “ACVA without MI”). The incidence of cardiovascular diseases (CVD), non-CVD comorbidities, drug therapy and outcomes were analyzed.

Results. In the group ACVA+MI compared with group ACVA without MI the significantly higher proportions of patients with the following conditions (diagnosis) were revealed: arterial hypertension (AH) – 99.1% and 94.2%; coronary heart disease (CHD) – 100% and 57%; chronic heart failure (CHF) – 61.5% and 41.8%; atrial fibrillation (AF) – 42.7% and 23.8%; repeated ACVA – 32.9% and 18.9%, respectively, p<0.0001 for all. In ACVA+MI and ACVA without MI groups the respective proportions of patients were smokers – 16.2% and 23.7% (p=0.10), had a family history of premature CVD – 3.2% and 1.2% (p=0.01), and had a hypercholesterolemia – 47% and 59.7% (p<0.001). The incidence of drug administration with proved positive prognostic effect was insufficient in both groups, but higher in the ACVA+MI group compared with ACVA without MI group (on average 47.1% and 40%, respectively), including: anticoagulants in AF – 19.1% and 21.4% (p=0.55); antiplatelets in CHD without AF – 69.4% and 42% (p<0.001); statins in CHD – 26.4% and 17.2% (p<0.001); beta-blockers in CHF – 39% and 23.8% (p=0.002), respectively. During 4- year follow-up in the group ACVA+MI compared with group ACVA without MI there were significantly higher all-cause mortality – 44.9% and 26.8% (p<0.001), nonfatal recurrent ACVA – 13.7% and 5.6% (p=0.0001), and nonfatal MI – 6.9% and 1.0% (p<0.0001), respectively.

Conclusion. The proportion of patients with a history of MI was 18.9% among the patients with a history of ACVA. In patients of ACVA+MI group, compared with patients of ACVA without MI group a higher incidence of the following characteristics was revealed: a presence of AH, CHD, CHF, AF, repeated ACVA and a family history of premature CVD. The incidence of taking drug with proved positive effect on prognosis in patients of the compared groups was insufficient, especially of statins and anticoagulants in AF. During the follow-up period ACVA+MI group was characterized by a higher all-cause mortality and higher incidence of nonfatal ACVA and MI. In these patients the improvement of the quality of pharmacotherapy and of the secondary prevention effectiveness are the measures of especial importance. 

About the Authors

E. Yu. Okshina
National Medical Research Center for Preventive Medicine
Russian Federation

MD, PhD, Senior Researcher, Department of Clinical Cardiology and Molecular Genetics,

Petroverigsky per. 10, Moscow, 101990



M. M. Loukianov
National Medical Research Center for Preventive Medicine
Russian Federation

MD, PhD, Head of Department of Clinical Cardiology and Molecular Genetics,

Petroverigsky per. 10, Moscow, 101990



S. Yu. Martsevich
National Medical Research Center for Preventive Medicine
Russian Federation

MD, PhD, Professor, Head of Department of Preventive Pharmacotherapy,

Petroverigsky per. 10, Moscow, 101990



S. S. Yakushin
Ryazan State Medical University named after Academician I.P. Pavlov
Russian Federation

MD, PhD, Professor, Head of Chair of Hospital Therapy,

Visokovoltnaya ul. 9, Ryazan, 390026



N. P. Kutishenko
National Medical Research Center for Preventive Medicine
Russian Federation

MD, PhD, Head of Laboratory for Pharmacoepidemiological Research, Department of Preventive Pharmacotherapy,

Petroverigsky per. 10, Moscow, 101990



A. N. Vorobyev
Ryazan State Medical University named after Academician I.P. Pavlov
Russian Federation

MD, PhD, Assistant, Chair of Hospital Therapy,

Visokovoltnaya ul. 9, Ryazan, 390026



K. G. Pereverzeva
Ryazan State Medical University named after Academician I.P. Pavlov
Russian Federation

MD, Assistant, Chair of Hospital Therapy,

Visokovoltnaya ul. 9, Ryazan, 390026



A. V. Zagrebelnyy
National Medical Research Center for Preventive Medicine
Russian Federation

MD, PhD, Senior Researcher, Department of Preventive Pharmacotherapy,

Petroverigsky per. 10, Moscow, 101990



V. P. Voronina
National Medical Research Center for Preventive Medicine
Russian Federation

MD, PhD, Senior Researcher, Department of Preventive Pharmacotherapy,

Petroverigsky per. 10, Moscow, 101990



N. A. Dmitrieva
National Medical Research Center for Preventive Medicine
Russian Federation

MD, PhD, Senior Researcher, Department of Preventive Pharmacotherapy,

Petroverigsky per. 10, Moscow, 101990



O. V. Lerman
National Medical Research Center for Preventive Medicine
Russian Federation

MD, PhD, Senior Researcher, Department of Preventive Pharmacotherapy,

Petroverigsky per. 10, Moscow, 101990



E. V. Kudryashov
National Medical Research Center for Preventive Medicine
Russian Federation

Programmer, Laboratory of Biostatistics,

Petroverigsky per. 10, Moscow, 101990



S. A. Boytsov
National Medical Research Center of Cardiology
Russian Federation

MD, PhD, Professor, Corresponding Member of the Russian Academy of Sciences, 

Tretya Cherepkovskaya ul. 15a, Moscow, 121552 



O. M. Drapkina
National Medical Research Center for Preventive Medicine
Russian Federation

MD, PhD, Professor, Corresponding Member of the Russian Academy of Sciences, Director,

Petroverigsky per. 10, Moscow, 101990



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For citation:


Okshina E.Y., Loukianov M.M., Martsevich S.Y., Yakushin S.S., Kutishenko N.P., Vorobyev A.N., Pereverzeva K.G., Zagrebelnyy A.V., Voronina V.P., Dmitrieva N.A., Lerman O.V., Kudryashov E.V., Boytsov S.A., Drapkina O.M. Patients with History of Myocardial Infarction and Acute Cerebrovascular Accidentin Clinical Practice: Demographic, Clinical Characteristics, Drug Treatment and Outcomes (Data of Outpatient and Hospital Registry REGION). Rational Pharmacotherapy in Cardiology. 2019;15(5):656-662. (In Russ.) https://doi.org/10.20996/1819-6446-2019-15-5-656-662

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