Pharmacotherapy after myocardial infarction

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Pharmacotherapy after myocardial infarction. The reality of coronary prevention in Brno , or else Is pharmacotherapy after myocardial infaction sufficient. REPERFUSION. PTCA. Direct PCI for all STEMI. PTCA. 60/1,000,000 = 1992 624/1,000,000 = 1998 1,220/1,000,000 = 2006 20x. PTCA. - PowerPoint PPT Presentation

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<ul><li><p>MethodsCollection of data on patients with history of myocardial infarction &gt; 1 month.Outpatient follow-up in University Hospital Brno from 1 Sept. 2009 to 31 Dec. 2009.Brno 2 registry of patient post myocardial infarction</p><p>Institute of Biostatistics and Analyses Masaryk Universitywww.iba.muni.cz; www.muni.cz </p><p>850 pts - age and genderAge (years)% of patientsAge (category)70 years or youngerover 70 yearsGenderMaleFemaleN = 850</p><p>Number%Total850GenderM (male)65076.5%F (female)20023.5%Age70 years or younger57668.6%over 70 years26431.4%Age mean (SD);median (5-95%)64 (10.8); 64 (46-82)</p><p>Institute of Biostatistics and Analyses Masaryk Universitywww.iba.muni.cz; www.muni.cz </p><p>Number of myocardial infarctions and age at the first infarctionAge at time of first MI (years)% of patientsN = 850 1st MITotal 60.5 yearsMen 59.0 yearsWomen 65.5 years</p><p>TotalMaleFemale70 years or youngerover 70 yearsNumber of MIs:1 x MI87.8%87.5%88.5%90.3%83.0%2 x MI9.5%9.5%9.5%8.0%12.1%more than 2 x MI2.7%2.9%2.0%1.7%4.9%</p><p>Institute of Biostatistics and Analyses Masaryk Universitywww.iba.muni.cz; www.muni.cz </p><p>Blood pressureless than 130/80130/80 to 140/90more than 140/90Total (N=850)Men (N=650)Women (N=200)70 years or younger (N=576)over 70 years (N=264)</p><p>Institute of Biostatistics and Analyses Masaryk Universitywww.iba.muni.cz; www.muni.cz </p><p>Blood pressure categories Optimal BPNormal BPHigh normal BPHT 1st degreeHT 2nd degreeHT isol. diastolicHT isol. systolic HT 3rd degree.* significant difference at level 0.05</p><p>Institute of Biostatistics and Analyses Masaryk Universitywww.iba.muni.cz; www.muni.cz </p><p>Blood pressureN = 850mmHg95%5%BP - systolemmHgBP - diastoleover 70 years70 years or youngerFemaleMaleTotal70 years or younger70 years or youngerOver 70 yearsOver 70 yearsTotalMenWomenTotalMenWomen</p><p>75%Median</p><p>25%</p><p>Institute of Biostatistics and Analyses Masaryk Universitywww.iba.muni.cz; www.muni.cz </p><p>Heart rateN = 85095%5%Pulse (per minute)over 70 years70 years or youngerFemaleMaleTotal# significant difference at level </p></li><li><p>BP &lt; 140/90 mmHg 60.1%ISH 19.6%Cholesterol &lt; 5 mmol/l - 72.5%Brno 2 Achievement of target values</p><p>Institute of Biostatistics and Analyses Masaryk Universitywww.iba.muni.cz; www.muni.cz </p><p>Medication Total (N=850)Men (N=650)Women (N=200)70 yrs or younger (N=576)over 70 years (N=264)RAASBetablockersStatinsAntiaggregation</p><p>ACEI or ARBonly ACEIonly ARBACEI and ARBBetablockerStatinsASA or Clop.only ASAonly Clop.ASA and Clop.</p><p>Institute of Biostatistics and Analyses Masaryk Universitywww.iba.muni.cz; www.muni.cz </p><p>Medication drug combinationsAll groupsTriple combinationDouble combination1 group of drugsAntiaggregation - 0.5%RAAS - 0.2%Statins - 0.2%BB-Antiaggregation - 1.1%BB-Statins - 0.2%RAAS-Antiaggregation - 0.9%RAAS-BB - 0.2%RAAS-Statins - 0.7%Statins-Antiaggregation - 0.4%BB-Statins-Antiaggregation - 5.4%RAAS-BB-Antiaggregation - 4.5%RAAS-BB-Statins - 4.2%RAAS-Statins-Antiaggregation - 5.5%N = 850</p></li><li><p> low intermediate highPerindopril &lt; 2.5 2.5 9.9 &gt; 10Ramipril &lt; 2.5 2.5 9.9 &gt; 10Trandolapril &lt; 0.5 0.6 3.9 &gt; 4Brno 2 ACE inhibitors</p><p>Institute of Biostatistics and Analyses Masaryk Universitywww.iba.muni.cz; www.muni.cz </p><p>ACEI dosinglow dosemoderate dosehigh dose</p><p>ACEI(N= 631)</p><p>Perindropril(N= 271)</p><p>Ramipril(N= 240)</p><p>Trandolapril(N= 51)</p></li><li><p> low intermediate highMetoprolol &lt; 25 25 199 &gt; 200Bisoprolol &lt; 2.5 2.5 9.9 &gt; 10Carvedilol &lt; 12.5 12.5 - 49.9 &gt; 50Brno 2 betablockers</p><p>Institute of Biostatistics and Analyses Masaryk Universitywww.iba.muni.cz; www.muni.cz </p><p>Batablocker dosinglow dosemoderate dosehigh dose</p><p>Betablocker(N= 777)</p><p>Metoprolol(N= 312)</p><p>Bisoprolol(N= 252)</p><p>Carvedilol(N= 124)</p></li><li><p> low intermediate highAtorvastatin &lt; 10 11 79 &gt; 80Simvastatin &lt; 20 21 79 &gt; 80Fluvastatin &lt; 20 21 79 &gt; 80Brno 2 statins</p><p>Institute of Biostatistics and Analyses Masaryk Universitywww.iba.muni.cz; www.muni.cz </p><p>Statin dosinglow dosemoderate dosehigh dose</p><p>Statins(N= 786)</p><p>Atorvastatin(N= 555)</p><p>Simvastatin(N= 123)</p><p>Fluvastatin(N= 75)</p></li><li><p>4 drug groups 75.8%RAAS blockade 92.2%Beta blockade91.5%Statins 92.6%Antiaggregation 94.0%Brno 2 Pharmacotherapy - 1</p></li><li><p>High dose ACEI 15.3%Perindopril 11.4%High dose statins 15.7%Atorvastatin 5.1%Brno 2 Pharmacotherapy - 2</p><p>Institute of Biostatistics and Analyses Masaryk Universitywww.iba.muni.cz; www.muni.cz </p><p>Medication in relationship to blood pressureBlood pressurelow dosemoderate dosehigh doseRAAS dosingBB dosingBoth doses high* Due to low number of patients in these categories, results are only for rough information</p><p>HT 1st degree(N= 74)</p><p>HT 2nd degree(N= 34)</p><p>HT 3rd degree(N=8)*</p><p>Institute of Biostatistics and Analyses Masaryk Universitywww.iba.muni.cz; www.muni.cz </p><p>BB dosign based on heart rate low dosemoderate dosehigh dose</p><p>HR 100 N=6</p><p>HR 99-90N=19</p><p>HR 89-80N=70</p><p>Institute of Biostatistics and Analyses Masaryk Universitywww.iba.muni.cz; www.muni.cz </p><p>Medication in relationship to cholesterol levelsCholesterollow dosemoderate dosehigh doseStatin doseno statins</p><p> 6.0 mmol/l(N= 68)</p><p>5.05.9 mmol(N= 155)</p><p>4.54.9 mmol(N= 142)</p></li><li><p>Average age Men59.0 yearsAverage age Women65.5 yearsBrno 2 Conclusions - 1</p></li><li><p>BP &lt; 140/90 60.1%ISH 19.6%Chol &lt; 5.0 mmol/l 72.5%All 4 drugs 75.8%Each drug group &gt; 90% Brno 2 Conclusions - 2</p></li><li><p>Insufficient dosing of ACEI, betablockers and statinsBrno 2 Conclusions - 3</p></li><li><p>Czech republic is among the best in Europe in pharmacotherapy of patients post MI and in achievement of target values. Brno 2 Conclusions - 4</p><p>Emerging new risk factorsContent points:Other risk factors that can qualitatively help in assessing CV risk include: Proteinuria: Recent data from HOPE show that the association between proteinuria is continuous and extends below the threshold for microalbuminuria.10 Renal insufficiency: In the Hypertension Detection and Follow-Up Program (HDFP), a serum creatinine concentration &gt;133 mmol/L (1.5 mg/mL) was a strong predictor of CV disease.11 The relation between serum creatinine and CV risk was linear, with a 5-fold difference in risk between the highest and lowest strata. - Subgroup analysis of the HOPE population by Mann et al extended these results by demonstrating a continuous relation between serum creatinine and CV risk in normotensive as well as hypertensive patients.12 Approximately one third of patients with renal insufficiency had microalbuminuria, and the CV risks associated with each were additive. Cardiometabolic syndrome (Discussed on the next slide.)Emerging new risk factorsContent points:Other risk factors that can qualitatively help in assessing CV risk include: Proteinuria: Recent data from HOPE show that the association between proteinuria is continuous and extends below the threshold for microalbuminuria.10 Renal insufficiency: In the Hypertension Detection and Follow-Up Program (HDFP), a serum creatinine concentration &gt;133 mmol/L (1.5 mg/mL) was a strong predictor of CV disease.11 The relation between serum creatinine and CV risk was linear, with a 5-fold difference in risk between the highest and lowest strata. - Subgroup analysis of the HOPE population by Mann et al extended these results by demonstrating a continuous relation between serum creatinine and CV risk in normotensive as well as hypertensive patients.12 Approximately one third of patients with renal insufficiency had microalbuminuria, and the CV risks associated with each were additive. Cardiometabolic syndrome (Discussed on the next slide.)</p></li></ul>