ABSTRACT
Background: The objective of this study is to examine the impact of medication adherence on the timing of non-cardiovascular serious events (NCDS) onset in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). Methods: This prospective study was conducted at a single center and involved 220 ACS patients who underwent sequential PCI with stenting. The Morisky Green Levine Medication Adherence Scale was employed to assess adherence to dual antiplatelet therapy (DAPT) and its impact on NCDS occurrence. Early in their hospitalization, all patients received education at the Coronary Heart Disease School. The survival rates of patients in both the main group and a control group (n=355) were subsequently evaluated. Results: The study findings indicated an inverse relationship between stent thrombosis development (Rho=-0.334; p=0.001) and the timing of recurrent myocardial ischemia. There was also an inverse correlation between patient adherence and stent thrombosis development (Rho=-0.275; p=0.009). Non-adherent individuals had a 16.8 times higher likelihood of experiencing stent thrombosis compared to compliant patients (p<0.001). Following participation in the CHD School program, treatment adherence increased from 56.5% to 88.2%. Education for ACS patients post-stenting was significantly associated with all-cause mortality within the first 6 months (p=0.040). Conclusion: Secondary preventive measures, including education, impact the success of endovascular interventions in both the early hospital phase and the long term. Patient education can serve as a supplementary intervention to enhance DAPT adherence, thus diminishing the risk of recurrent cardiovascular events and mortality post endovascular intervention.
ABSTRACT
PURPOSE: to elucidate independent clinical and laboratory predictors of adverse cardiovascular events (ACVE) in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) with stenting in early inhospital period. MATERIALS AND METHODS: We included in this prospective single center study 130 patients with ACS who underwent PCI with stenting. All patients prior to and after PCI received dual antiplatelet therapy with acetylsalicylic acid and clopidogrel. In 12-48 hours after PCI we measured residual platelet reactivity (RPR) using light aggregometry. In 57 patients simultaneously we performed genotyping of CYP2C19*2 polymorphisms. The following ACVE were used as end-points and were registered during inhospital observation (mean duration 9.7±3.2 days): sudden death, stent thrombosis, arterial thrombosis of other localization, recurrent angina, cardiac rhythm disturbances requiring special therapy. RESULTS: Repetitive ACVE were observed in 32 patients. According to unifactorial regression analysis risk factors of their development were, ADP F-induced RPR (Ñ<0.001), levels of creatinine (Ñ<0.001), hemoglobin (Ñ<0.001), and glucose (Ñ=0.026), age (Ñ=0.01), iron-deficiency anemia (Ñ=0.01), left ventricular ejection fraction (Ñ=0.004), number of stents (Ñ=0.015). According to results of multifactorial regression analysis independent predictors of ACVE were: ADP-induced RPR >76 % (Ñ=0.003), levels of creatinine >189 µmol / L (Ñ=0.003), and hemoglobin <114 g / L (Ñ=0.004). Significant effect of homozygous carriage of CYP2C19*2 (G681A) (Ð / Ð) on development of stent thrombosis was also detected (Ñ=0.028). CONCLUSION: ADP-induced RPR, levels of creatinine and hemoglobin were found to be independent predictors of inhospital ACVE after myocardial revascularization with stenting in patients with ACS.
Subject(s)
Acute Coronary Syndrome , Percutaneous Coronary Intervention , Hospitalization , Humans , Platelet Aggregation Inhibitors , Prospective Studies , TiclopidineABSTRACT
In this article, we set forth the average values and reference intervals of platelet aggregation in practically healthy individuals on the AggRAM optical aggregometer. The reference intervals of platelet aggregation activity with 5 µg/ml adenosine-5`-diphosphate and the area under the aggregation curve were 67,4-92,5% and 54,5-85,3; the reference intervals of platelet activity with 10 µg/ml adenosine-5`-diphosphate and the area under the aggregation curve were 76,8-97,2%% and 68,8-90,4. The obtained values of indicators can be used as reference in the clinical diagnostic laboratory of the University Hospital of Semey State Medical University.
