Clinical characteristics and management of post-myocardial infarction patients with stable angina in the outpatient practice of Ukrainian cardiologists (GO-OD study)

Abstract

Aim. To identify the clinical and anamnestic characteristics and features of the stable angina management in patients with a history of myocardial infarction (MI) in the actual outpatient practice of Ukrainian cardiologists in order to determine the follow-up activities for optimizing and individualizing the treatment of this patient cohort.

Materials and methods. The non-interventional observational multicenter prospective study GO-OD enrolled 1529 patients with coronary artery disease, stable angina, 39.7 % of whom had a history of MI. The follow-up period for the study participants was 3 months. Physicians were instructed to continue monitoring and treatment of patients in accordance with routine practice and international guidelines. No additional diagnostic or monitoring procedures were performed. However, physicians could adjust therapy and provide recommendations for lifestyle modification.

Results. Among post-infarction patients, the proportion of young people, active smokers and men was significantly higher (p < 0.001). A positive family history of MI in first-degree relatives or sudden death in the patient’s father before 55 years of age have been identified to be more common in MI patients (p < 0.05), a positive family history of stroke has been found in the group of patients without MI (p < 0.001). Patients with MI had an average of 6 anginal attacks per week, and the need for short-acting nitroglycerin to relieve attacks was significantly higher than that in patients without MI. PCI was used more often for MI patients within up to 3 years post-MI, the proportion of CABG gained prevalence among patients over 3 years after MI. At the time of study enrollment, the patients mostly used beta-blockers, trimetazidine was the second most often prescribed. When optimizing antianginal therapy, trimetazidine therapy underwent the greatest modifications, the proportion of patients taking beta-blockers and calcium antagonists also increased, which resulted in a significant symptom alleviation in patients. Recommended highly intensive statin therapy was prescribed only to 44.2 % of patients and none of the patients received combined lipid-lowering therapy.

Conclusions. Controlling the modifiable risk factors remains unsatisfactory among Ukrainian outpatients with angina and a history of MI. Despite prior coronary revascularization procedures, significant symptomatology in patients with angina and MI has been detected. Low therapy adherence has been documented in most patients. Fewer than half of patients with a history of MI receive the required doses of statins. Pharmacological therapy optimization through adjustment of hypolipidemic and antianginal medication dosages, and the inclusion of original trimetazidine at a dose of 80 mg once a day have resulted in a significantly reduced frequency of anginal attacks and improved quality of patients’ life.