PROSPECTIVE OUTPATIENT REGISTRY OF MYOCARDIAL INFARCTION PATIENTS (PROFILE-MI): STUDY DESIGN AND FIRST RESULTS

Aim. To characterize patients included to the registry PROFILE-MI; to present data reflecting the condition of patients before the onset of acute myocardial infarction (MI).Material and methods. Totally, 160 patients included: 106 males, 54 females — 66,2%/33,8%, respectively, consequently visited cardiologist in the City Polyclinics №9 of Moscow or one of two its branches, after hospitalization for MI.Results. Mean age of patients 70,4±10,8 (39-87) y.o., males were in average 10 years younger than women. About 40% were >60 y.o., about a half were retired, and of those most were women, ~1/3 of patients were already disabled; in ~3/4 there was arterial hypertension. For smoking and lipid disorders, in most patients there was no data: only for 29,4 and 46,9%, respectively; diabetes was found in 28,1%. Anamnesis of coronary heart disease (CHD) had been registered in anamnesis of 47 (29.4%), and most of those already experienced myocardial infarction (MI). Half of the included patients had had visited medical institutions during 2 year period before the MI event, most of them — local outpatient institutions (polyclinics), but 1/3 of patients did not request for medical help during last ≥2 years.Conclusion. Patients included to PROFILE-MI registry, had in general similar demographic and clinical parameters with other registries of MI in Russia. Most post MI patients already had cardiovascular diseases of atherosclerotic origin, or a combination of traditional CHD risk factors, so MI onset was quite predictable. Most of them were not under the coverage of primary and secondary CHD preventions before MI event

Assessment of the Adequacy of Drug Choice in Patients with Acute Myocardial Infarction According to the PROFILE-IM Registry

Background. The prognosis for patients after acute myocardial infarction (AMI) can be improved by prescribing beta-blockers (BB), angiotensin converting enzyme inhibitors (ACEI) and statins. This is reflected in the current clinical guidelines, in which these drugs are considered mandatory for almost all patients after AMI. However, not all representatives of the same drug class have the same evidence base in relation to the impact on the outcomes of AMI, in addition, not all BB and ACEI, according to the official instructions have the indication "recent AMI".Aim. To assess the adequacy of the choice of BB, ACEI and angiotensin receptor antagonists (ARA), prescribed after recent AMI, using the materials of the prospective registry PROFILE-IM.Material and methods. 1 60 patients after AMI referred to outpatient clinic from March 01,2014 to June 30, 201 5 were included into the registry. The therapy prescribed to patients at discharge from the hospital and at the first visit to the outpatient clinic were evaluated, special attention was paid to three classes of drugs: BB, ACEI/ARA.Results. The majority of patients were recommended ACEI/ARA (88.1%) and BB (98.8%) at discharge from hospital. Not prescribing of these groups of drugs in about half of the cases had a reasonable cause, for ACEI/ARA in 13 patients (8.1%) the cause could not be clarified. When choosing a BB in most cases (both in hospital and in the outpatient clinic) preference was given to bisprolol (61% and 67%, respectively), which has no evidence of prognosis improvement for patients after AMI, the second place took metoprolol, its prescription was two times less than bisprolol. When choosing ACEI, priority was given to perindopril, with which no one randomized clinical trial was carried out in patients after AMI (38% of prescriptions in the hospital and 41% - in the outpatient clinic). Enalapril took the second place (20% and 22%, respectively), the remaining ACEI were prescribed much less frequently, ARA were also prescribed rarely (5%).Conclusion. After AMI the majority of patients were prescribed BB, ACEI/ARA, which in accordance with current clinical guidelines are necessary to improve long-term outcomes. However, the choice of a specific drug within the drug class not always consistent with evidence-based medicine, current clinical guidelines and the official instructions for the medical use. In this regard, patients after AMI do not receive all the benefits of drug therapy to improve long-term outcomes

OUTPATIENT REGISTRY OF PATIENTS WITH ACUTE MYOCARDIAL INFARCTION (PROFILE-IM): DATA ON PREHOSPITAL THERAPY IN COMPARISON WITH THE LIS-3 REGISTRY

Aim. To study the quality of prehospital therapy in patients with a history of acute coronary syndrome/acute myocardial infarction (ACS/AMI), and included in 2 registers: LIS-3 and PROFILE-IM.Material and methods. Data on therapy before the reference ACS in the hospital register LIS-3 (Lyubertsy town, 01.11.2013-31.07.2015) and in the AMI outpatient registry PROFILE-IM (Moscow city polyclinic N9) were compared. Anonymized data from the case histories (320 patients from the LIS-3 registry) and outpatient charts (160 patients from the PROFILE-IM register) were analyzed.Results. Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers before AMI in patients from PROFILE-MI were prescribed significantly more often than in the LIS-3 registry (49.4% vs 39.4%, respectively, p<0.05), as well as calcium channel blockers – 6.7% vs 5.3%, respectively (p<0.05). The frequency of prescription of statins, antiplatelet agents and anticoagulants before reference AMI in patients of both registers did not differ significantly. Assessment of adherence to treatment was performed in the PROFILE-IM registry. 56 (35.0%) patients did not take medication. Among cases with pharmacotherapy only 41 (39.4%) patients had regular taking, and 24 (23.1%) took medication in worsening health, 39 (37.5%) had only short medication courses. Similar data were revealed in patients already having ischemic heart disease.Conclusion. Primary and secondary drug prevention of AMI in both registries did not meet modern clinical guidelines. This was especially true for patients with already established ischemic heart disease and to the greatest extent, according to both registries, refers to drugs from the statin group

Effect of Previous Cardiovascular Diseases on Long-Term Outcomes of Acute Myocardial Infarction: Data of the Outpatient Registry "PROFILE-IM”

Aim. Within the framework of the outpatient registry of patients with acute myocardial infarction (AMI), to assess the influence of factors in medical history, especially cardiovascular diseases (CVD) preceding AMI, on the long-term results of the underlying disease.Material and methods. 160 patients who  sought medical care to the outpatient clinic from March  01,  2014 to June 30,  2015 after  AMI were included into the registry. Patients were observed for at least 1 year (maximum 2.5 years). The primary end point (PEP) of the study were death from any cause,  recurrent cardiovascular complications (non-fatal AMI, cerebral stroke), and urgent hospitalization due to the worsening of the current CVD.Results. After 1 year of follow-up, 9 (6%) patients died (8 from CVD). A recurrent myocardial infarction occurred in 8 patients, and cerebral stroke in 1 patient. 20 patients were hospitalized due to CVD exacerbation. In total PEP was registered in a fifth part of patients (36 people). Factors that had a negative impact on the endpoint were age (relative risk [RR] 1,05; 95% confidence interval [CI] 1.01-1.09, p=0.016), the presence of cardiovascular diseases or conditions reflecting the severity of the underlying disease before the reference event: ischemic heart disease (RR 2.37; 95%CI 1.05-5.34, p=0.038), previously AMI (RR=5.93; 95%CI 2.28-15.4, p<0.001), percutaneous coronary intervention (RR 9.84; 95%CI 2.02-48.06, p<0.005), disability (RR 4.37; 95%CI 1.82-10.46, p<0.001).Conclusion. The long-term life and  disease prognosis in patients with AMI remains quite severe.  Adverse long-term outcomes of the  disease are largely determined by anamnestic factors, primarily the  presence of ischemic heart  disease before  the  reference event,  previous AMI. The study indirectly demonstrated that percutaneous coronary intervention in patients with stable ischemic heart disease, at least, does not improve the prognosis of the disease

The Main Cardiovascular Complications and Mortality Rates During the First One and a Half Years after Acute Myocardial Infarction: Data from the Prospective Outpatient Registry PROFILE-IM

Aim. To study the long-term outcomes of patients who survived after acute myocardial infarction (AMI) in a prospective outpatient registry.Material and methods. Patients (n=160) who applied to one of the outpatient clinics in Moscow after AMI were included in the registry PROFILE-MI. The total follow-up period was 1.5 years. The primary combined endpoint (PCE) included death from any cause, cardiovascular events (nonfatal myocardial infarction, nonfatal cerebral stroke), emergency hospitalizations for cardiovascular diseases, significant cardiac arrhythmias. 1-year observation period was taken in analysis of the factors affecting the development of PCE.Results. During the observation period, 16 patients (10%) died. Life status was not obtained in 4 patients. Most of the deaths were due to cardiovascular complications; in a quarter of patients, repeated AMI was the cause of death. After 12 months of follow-up, the development of PCE was observed in 42 patients. PCE has been identified more often in elderly patients, in patients who had certain complications in the acute period of AMI, in patients who had swelling at the time of the examination in the outpatient clinic, who complained of shortness of breath, and also had a heart rate (HR) more than 70 min-1. Normal blood pressure (within 120/80-139/89 mm Hg) and HR at 60-70 min-1 had a positive prognostic influence. Conclusion. Despite intensive treatment in a hospital and the relatively high quality of secondary pharmacological prevention, the prognosis of life and disease in patients after AMI remains quite serious