Lviv clinical bulletin 2019, 1(25): 34-38

The Effects of Dual Antiplatelet Therapy on the Occurrence of Recurrent Cardiovascular Events After Myocardial Infarction in Obese Patients

K. Borovyk, N. Rindina, P. Kravchun, O. Tabachenko, O. Yermak, M. Romanyuk

Kharkiv National Medical University

Introduction. Acute myocardial infarction (AMI) with ST elevation (STEMI) is still the main cause of mortality and invalidisation of able­bodied population. Regardless of the primary percutaneous coronary intervention (PCI) or thrombolysis, dual antiplatelet therapy (DAPT) remains the main therapeutic strategy, both in the acute STEMI period and in the remote, for the secondary prevention of possible adverse cardiovascular events, and it is a combination of acetylsalicylic acid (ASA) and a P2Y12 receptor inhibitor. Today, according to the recommendations of the European Society of Cardiologists in 2017, the drug of choice is clopidogrel and ticagrelor. To date, the issue of the choice of a P2Y12 receptor inhibitor in the DAPT that is used in the treatment of STEMI is an urgent subject of scientific discussion.

The aim of the study. The aim of the study. To analyze the incidence of recurrent cardiovascular events in obese patients after myocardial infarction during a 6month followup period, depending on the combination of ticagrelor or clopidogrel with acetylsalicylic acid as part of dual antiplatelet therapy.

Materials and methods. The study involved 75 patients with AMI with ST segment elevation and concomitant obesity. The patients were divided into 2 subgroups: the first included 31 patients who received the combination of ASA + ticaglelor, and the second ­ 44 patients treated with the combination of ASA + clopidogrel in the DAPT. The GRACE scale was used to stratify the risk of hospital and 6­month mortality. Control of the recurrent cardiovascular events presence was carried out after 6 months.

Criteria for exclusion were acute and chronic inflammatory processes, Q­negative AMI, diffuse connective tissue diseases, oncological diseases, concomitant diseases of the thyroid gland, and the presence of symptomatic hypertension.

Results. While observing patients after MI with concomitant obesity over a period of 6 months, it was found that 28 patients had a recurrent MI and/or unstable angina (UA), which was 37.56 % of all patients. The analysis of GRACE scale scores in a cohort of patients with recurrent cardiovascular events revealed that all patients were included in high risk group (>118 points). In the group of patients who received DAPT with the involvement of ASA and ticagrelor, in 11 people a repeated MI and/or UA were recorded, which was 14.76 %. At the same time, in a group of patients receiving DAPT in a combination of ASA with clopidogrel, re­cardiovascular catastrophes were detected in 17 patients, which was 22.8 % of all patients with STEMI on the background of concomitant obesity (p < 0.05 ­ when compared with the second group (DAPT ASA + clopidogrel)).

Consequently, in the group of patients whose treatment included ASA with ticagrelor in DAPT, re­occurrence of coronary events was observed fewer than in the group of patients receiving ASA with clopidogrel (p < 0.05).

Conclusions. Most patients (69.30 %) with obesity after myocardial infarction were included in the high­risk group of six­month lethality in terms of the number of GRACE scale points. In 37.56 % of patients with acute myocardial infarction with elevation of the ST segment and adjunctive obesity, there was a recurrent coronary event in the form of myocardial infarction or unstable angina in the presence of high GRACE score. A cohort of patients with obesity after myocardial infarction, which is included in the high­risk group on a six­month lethality scale, is recommended a treatment with the combination of acetylsalicylic acid and ticagrelor in view of the marked reduction in the risk of recurrent cardiovascular catastrophes compared with the combination of acetylsalicylic acid and clopidogrel (p < 0.05).


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