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Risk Stratification after an Acute Coronary Syndrome: Significance of Antithrombotic Therapy

The impact of the de-escalation strategy of antiplatelet therapy (APT) on the life expectancy after acute coronary syndromes (ACS) and percutaneous coronary intervention (PCI) requires an assessment in real clinical practice. Into the Russian multicentral observational trial (ORACLE II ClinicalTrial...

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Autores principales: Brazhnik, Victoria A., Minushkina, Larisa O., Boeva, Olga I., Khasanov, Niyaz R., Kosmacheva, Elena D., Chichkova, Marina A., Zateyshchikov, Dmitry A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8068298/
https://www.ncbi.nlm.nih.gov/pubmed/33917922
http://dx.doi.org/10.3390/jcm10081572
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author Brazhnik, Victoria A.
Minushkina, Larisa O.
Boeva, Olga I.
Khasanov, Niyaz R.
Kosmacheva, Elena D.
Chichkova, Marina A.
Zateyshchikov, Dmitry A.
author_facet Brazhnik, Victoria A.
Minushkina, Larisa O.
Boeva, Olga I.
Khasanov, Niyaz R.
Kosmacheva, Elena D.
Chichkova, Marina A.
Zateyshchikov, Dmitry A.
author_sort Brazhnik, Victoria A.
collection PubMed
description The impact of the de-escalation strategy of antiplatelet therapy (APT) on the life expectancy after acute coronary syndromes (ACS) and percutaneous coronary intervention (PCI) requires an assessment in real clinical practice. Into the Russian multicentral observational trial (ORACLE II ClinicalTrials.gov number, NCT04068909), 1803 patients with ACS and PCI indications were enrolled. During 12 months of follow-up, 228 all-cause deaths have occurred. The analysis of death predictors was carried out by the classification tree method. Age, an option of antithrombotic therapy, a history of chronic heart failure, and uric acid level had the greatest prognostic value. The death prediction model’s sensitivity was 82.1% in the training cohort and 79.2% in the test cohort. During the observation period, ticagrelor was replaced with clopidogrel (APT de-escalation) in 357 patients. The groups of patients with different antiplatelet therapy options were adjusted for clinical parameters by the pseudorandomization method. The de-escalation group had the lowerest all-cause death rate. The incidence of bleeding and recurrent nonfatal coronary events in the study groups did not differ significantly. Thus, the APT regimen’s advantage of changing from the maximum in the first weeks after ACS to moderate at follow-up has been confirmed. There is an obvious need to study the possibilities of individualizing antiplatelet therapy in patients after acute coronary syndromes.
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spelling pubmed-80682982021-04-25 Risk Stratification after an Acute Coronary Syndrome: Significance of Antithrombotic Therapy Brazhnik, Victoria A. Minushkina, Larisa O. Boeva, Olga I. Khasanov, Niyaz R. Kosmacheva, Elena D. Chichkova, Marina A. Zateyshchikov, Dmitry A. J Clin Med Article The impact of the de-escalation strategy of antiplatelet therapy (APT) on the life expectancy after acute coronary syndromes (ACS) and percutaneous coronary intervention (PCI) requires an assessment in real clinical practice. Into the Russian multicentral observational trial (ORACLE II ClinicalTrials.gov number, NCT04068909), 1803 patients with ACS and PCI indications were enrolled. During 12 months of follow-up, 228 all-cause deaths have occurred. The analysis of death predictors was carried out by the classification tree method. Age, an option of antithrombotic therapy, a history of chronic heart failure, and uric acid level had the greatest prognostic value. The death prediction model’s sensitivity was 82.1% in the training cohort and 79.2% in the test cohort. During the observation period, ticagrelor was replaced with clopidogrel (APT de-escalation) in 357 patients. The groups of patients with different antiplatelet therapy options were adjusted for clinical parameters by the pseudorandomization method. The de-escalation group had the lowerest all-cause death rate. The incidence of bleeding and recurrent nonfatal coronary events in the study groups did not differ significantly. Thus, the APT regimen’s advantage of changing from the maximum in the first weeks after ACS to moderate at follow-up has been confirmed. There is an obvious need to study the possibilities of individualizing antiplatelet therapy in patients after acute coronary syndromes. MDPI 2021-04-08 /pmc/articles/PMC8068298/ /pubmed/33917922 http://dx.doi.org/10.3390/jcm10081572 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Brazhnik, Victoria A.
Minushkina, Larisa O.
Boeva, Olga I.
Khasanov, Niyaz R.
Kosmacheva, Elena D.
Chichkova, Marina A.
Zateyshchikov, Dmitry A.
Risk Stratification after an Acute Coronary Syndrome: Significance of Antithrombotic Therapy
title Risk Stratification after an Acute Coronary Syndrome: Significance of Antithrombotic Therapy
title_full Risk Stratification after an Acute Coronary Syndrome: Significance of Antithrombotic Therapy
title_fullStr Risk Stratification after an Acute Coronary Syndrome: Significance of Antithrombotic Therapy
title_full_unstemmed Risk Stratification after an Acute Coronary Syndrome: Significance of Antithrombotic Therapy
title_short Risk Stratification after an Acute Coronary Syndrome: Significance of Antithrombotic Therapy
title_sort risk stratification after an acute coronary syndrome: significance of antithrombotic therapy
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8068298/
https://www.ncbi.nlm.nih.gov/pubmed/33917922
http://dx.doi.org/10.3390/jcm10081572
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