Long-term follow-up of antithrombotic management patterns in patients with acute coronary syndrome in Russia: an observational study (EPICOR-RUS study)

Abstract

Objective: This study sought to describe the short- and long-term (up to 2 years) antithrombotic management patterns in a real-life setting for patients hospitalized for an acute coronary syndrome (ACS) event, and to document clinical outcomes.

Research design and methods: EPICOR-RUS was a multicenter (34 centers), prospective, observational, longitudinal cohort study conducted across Russia on antithrombotic management in hospitalized (within 24 hours of symptom onset) ACS patients with 2 year follow-up.

Clinical trial registration: NCT01373957.

Results: A total of 600 ACS patients (71.1% male, mean age 60 years) were enrolled; 599 were included for analysis. Diagnosis comprised STEMI (n = 375, 62.6%), NSTEMI (n = 147, 24.5%), and unstable angina (UA) (n = 77, 12.9%). Percutaneous coronary intervention (PCI) was conducted in 64.3% of patients with STEMI (with or without thrombolysis), 36.7% with NSTEMI, and 58.4% with UA. There was undertreatment with dual antiplatelet therapy (DAPT) for STEMI, NSTEMI, and UA: 14.7%, 25.9% and 16.9% of patients, respectively, were not receiving DAPT during hospitalization, and 10.1%, 21.8% and 16.9% at discharge. Post-discharge, of the STEMI group, only 72.4% of patients who were managed by PCI and 39.8% of conservatively treated patients received DAPT at 12 months. The respective figures in the NSTEMI group were 77.3% and 26.4%. In the STEMI cohort the cumulative incidence of all-cause mortality was 3.2% at 1 year and 5.1% at 2 years of follow-up; in the NSTEMI cohort this was 2.7% and 4.8%, respectively. There were no deaths by 12 months and one death by 24 months (1.3%) in the UA population.

Conclusion: Despite evidence-based guidelines for the management of ACS, the real-world setting in Russia shows discrepancies in clinical practice, highlighting the need for improvements for the optimal management of high-risk patients with ACS.

Keywords:

• Acute coronary syndrome
• antithrombotic agents
• clinical outcomes
• observational study
• quality of life
• real-world

Transparency

Declaration of funding

The study was funded by AstraZeneca.

Declaration of financial/other relationships

O.V.A. and M.Y.R. have disclosed that they are national coordinators of AstraZeneca studies and AstraZeneca speakers. Y.V.K. has disclosed that she is an employee of AstraZeneca.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Previous presentations: Averkov O, Khomitskaya Y, Ruda M. Pre-hospital antiplatelet treatment of acute coronary syndrome in Russia (EPICOR-RUS study). Accepted for poster presentation at the Acute Cardiac Care Congress, Madrid, Spain, 12–14 October 2013. Averkov O, Khomitskaya Y, Ruda M. Quality of key acute antithrombotic care in ST-elevation myocardial infarction in urban Russia (EPICOR-RUS study). Accepted for poster presentation at the 83rd Annual European Atherosclerosis Society Congress, Glasgow, UK, 22–25 March 2015. Khomitskaya Y, Ruda M, Averkov O, Apanova O. Duration of dual antiplatelet therapy in Russian patients after myocardial infarction (EPICOR-RUS study). Accepted for poster presentation at the 11th Biennial International Congress on Innovations in Coronary Artery Disease, Florence, Italy, 29 Nov–2 Dec 2015. Khomitskaya Y, Ruda M, Averkov O, Apanova O. Antiplatelet therapy pattern in non ST-elevation myocardial infarction in urban Russia (EPICOR-RUS study). Accepted for poster presentation at the 11th Biennial International Congress on Innovations in Coronary Artery Disease, Florence, Italy, 29 Nov–2 Dec 2015. Averkov OV, Khomitskaya YU, Ruda MYA. Long-term clinical outcomes after non-ST elevation myocardial infarction (NSTEMI) in a Russian population (EPICOR-RUS study). Accepted for poster presentation at the 5th Annual Congress of the Acute Cardiovascular Care Association, Lisbon, Portugal, 15–17 October 2016. Averkov OV, Khomitskaya YU, Ruda MYA. Dual antiplatelet therapy in Russian patients beyond 12 months after myocardial infarction (EPICOR-RUS study). Accepted for poster presentation at the 5th Annual Congress of the Acute Cardiovascular Care Association, Lisbon, Portugal, 15–17 October 2016. Khomitskaya YU, Averkov OV, Ruda MYA. Long-term clinical outcomes after ST elevation myocardial infarction (STEMI) in a Russian population (EPICOR-RUS study). Accepted for poster presentation at the 5th Annual Congress of the Acute Cardiovascular Care Association, Lisbon, Portugal, 15–17 October 2016.

Acknowledgments

The authors would like to thank the EPICOR-RUS investigators. Moscow: S.A. Belkov, S.R. Gilyarevsky, A.K. Gruzdev, A.Yu. Lebedeva, A.L. Syrkin, Z.S. Shogenov; Saint-Petersburg: S.A. Boldueva, A.Yu. Vishnevsky, G.I. Zalevsky, V.A. Kostenko, I.S. Masterov, A.V. Panov, T.G. Rybka, V.I. Simanenkov; Ekaterinburg: A.G. Malishevsky, O.G. Smolenskaya, E.G. Fokina; Krasnodar: V.V. Makukhin, N.A. Spiropolus; Samara: D.V. Duplyakov, M.A. Skuratova; Kirov: O.V. Solov’ev; Barnaul: G.A. Chumakova; Voronezh: S.I. Kuznetsov; Kemerovo: O.L. Barbarash; Krasnoyarsk: S.E. Golovenkin; Lubertsy: M.L. Ginsburg; Murmansk: G.V. Klein; Novosibirsk: D.I. Belen’ky; Petrozavodsk: N.N. Vesikova; Pskov: V.M. Soldatov; Tomsk: V.A. Markov; Tyumen: V.A. Kuznetsov; Cheboksary: V.V. Prokudin. The authors would like to acknowledge Kerry Acheson PhD CMPP, of iMed Comms, an Ashfield Company, part of UDG Healthcare plc for medical writing support that was funded by AstraZeneca.