| Autor: |
Brazhnik VA; Central State Medical Academy of Department of Presidential Affairs, 121359 Moscow, Russia.; City Clinical Hospital No. 51 of the Moscow City Healthcare Department, 121309 Moscow, Russia., Minushkina LO; Central State Medical Academy of Department of Presidential Affairs, 121359 Moscow, Russia., Boeva OI; Central State Medical Academy of Department of Presidential Affairs, 121359 Moscow, Russia., Khasanov NR; Department of Propedeutics of Internal Diseases, Kazan State Medical University, Ministry of Health Care of the Russian Federation, 420012 Kazan, Russia., Kosmacheva ED; Department of Propedeutics of Internal Diseases, Kuban State Medical University, Ministry of Health Care of the Russian Federation, 350063 Krasnodar, Russia., Chichkova MA; Astrakhan State Medical University, Ministry of Health Care of the Russian Federation, 414000 Astrakhan, Russia., Zateyshchikov DA; Central State Medical Academy of Department of Presidential Affairs, 121359 Moscow, Russia.; City Clinical Hospital No. 51 of the Moscow City Healthcare Department, 121309 Moscow, Russia. |
| Abstrakt: |
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. |
