Retrospective Analysis of Lipid-Lowering and Antiplatelet Therapy Regimen by Clinical Decision Support Service Based on Real-World Data from Electronic Medical Records "Intellect 3 Study".

Aim      To evaluate prescription of lipid-lowering and antithrombotic therapy in clinical practice and to compare differences in recommendations using the clinical decision support service (CDSS).Material and methods  Electronic medical records (EMR) of 300 patients from the Chazov National Medical Research Center of Cardiology, as well as from medical organizations controlled by the Department of Health of the Lipetsk Region and the Ministry of Health of the Voronezh Region, were analyzed for the period of August - December 2022, during the pilot implementation of CDSS. Retrospective information about the prescription of lipid-lowering and antithrombotic therapy from the EMR was compared with the CDSS guidelines under the expert supervision based on digitized clinical and laboratory profiles of patients. The study primary endpoint was a change in the initially prescribed lipid-lowering and / or antithrombotic therapy as per CDSS guidelines.Results Overall 292 patients were included in the final analysis; 46 (15.7 %) were from the primary prevention group and 246 (84.3 %) from the secondary prevention group. In group 1, the lipid-lowering therapy recommended by the CDSS differed by 50 % (p<0.001) from the baseline therapy recorded in the EMR. In the secondary prevention group, 78.9 % (p<0.001) differences were found in the lipid-lowering therapy recommended in the CDSS guidelines compared to the prescriptions in the EMR. In 76.8 % (p<0.001) of patients, antithrombotic therapy was significantly different from the baseline therapy in the EMR.Conclusion      The use of CDSS may improve the practice of choosing lipid-lowering and antithrombotic therapy for prevention of cardiovascular complications.

[Lipoprotein-associated phospholipase A2 serum levels in patients from different categories of cardiovascular risk].

AIM: To compare levels of lipoprotein-associated phospholipase A2 (Lp-PLA2) in blood serum of patients from different cardiovascular risk categories. MATERIAL AND METHODS: Patients from Moscow prospective study database (n = 519) were divided into 4 cardiovascular risk categories according to present clinical recommendations (low, moderate, high, very high). Measurement of Lp-PLA2 concentration (mass) was performed using PLAC Test ELISA Kit. Measurement of Lp-PLA2 activity was made using PLAC Test for Lp-PLA2 Activity. Blood serum levels of total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triglycerides (TG), lipoprotein (a) (Lp(a)), high sensitive C-reactive protein (hsCRP) and uric acid were also determined. RESULT: Preliminary analysis showed that associations between Lp-PLA2 mass and activity became more obvious in patients not treated with statins and patients without diabetes mellitus. So patients receiving statins and diabetics were excluded from final analysis. Lp-PLA2 mass and activity were lower in low cardiovascular risk category patients. There were no significant differences in Lp-PLA2 mass and activity between patients from moderate, high and very high risk categories. There was moderate correlation between Lp-PLA2 mass and Lp-PLA2 activity (r = 0.38, p < 0.00001). We did not find any correlation between Lp-PLA2 and hsCRP, Lp(a) levels, but detected moderate correlation between Lp-PLA2 mass and activity and TC, LDL-C. We also found a mild positive correlation between Lp-PLA2 mass and HDL-C levels. There was a positive correlation between Lp-PLA2 activity and TG, uric acid and negative correlation between Lp-PLA2 activity and HDL-C levels. CONCLUSION: In this group of nondiabetic patients not treated with statins both Lp-PLA2 activity and mass were similarly related to categories of cardiovascular risk.

[Myocardial infarction secondary to blunt chest trauma in a man of 25 years].

This paper describes the clinical case - anterior myocardial infarction after blunt chest trauma in a 25-year-old man.