rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2019-15-6-873-880rpcardio-2080Research ArticlePOINT OF VIEWТОЧКА ЗРЕНИЯNew Opportunities for Improving the Prognosis of Patients with Chronic Ischemic Heart DiseaseНовые возможности улучшения прогноза больных хронической ишемической болезнью сердцаПерепечН. Б.PerepechN. B.

Никита Борисович Перепеч – доктор медицинских наук, профессор, руководитель научно-клинического и образовательного центра «Кардиология»

199034, Санкт-Петербург, Университетская наб., 7/9 

Nikita B. Perepech – MD, PhD, Professor, Head of Clinical, Research and Education Center “Cardiology”

Universitetskaya nab. 7-9, St. Petersburg, 199034

nikita_perepech@mail.ruСанкт-Петербургский государственный университетРоссияSaint-Petersburg State UniversityRussian Federation201903012020156873880Copyright © Perepech N.B., 20202020Перепеч Н.Б.Perepech N.B.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/2080

Resources and methods for improving the prognosis in patients with chronic ischemic heart disease (IHD) are presented in the review. Information on the classes of drugs that improve the prognosis, and target values of the main physiological parameters that should be monitored during the treatment of patients with chronic IHD are also presented. The main attention is paid to antiplatelet agents and anticoagulants. The results of the most significant randomized clinical trials of the efficacy and safety of drugs from these classes in the treatment of chronic IHD are discussed. The results of the COMPASS study, which obtained confirmation of the positive effect of combined therapy with rivaroxaban and acetylsalicylic acid on the prognosis of patients with chronic IHD or peripheral artery disease, are presented in detail. The safety aspects of this therapy are discussed. The position of rivaroxaban in the treatment of patients with chronic IHD with sinus rhythm is presented according to the Recommendations of the European Society of Cardiology for the diagnosis and treatment of chronic IHD (2019).

Обзор посвящен средствам и методам улучшения прогноза больных хронической ишемической болезнью сердца (ИБС). Приведены сведения о классах лекарственных препаратов, доказано улучшающих прогноз, и целевых значениях основных физиологических параметров, которые должны контролироваться в процессе лечения пациентов с хронической ИБС. Основное внимание уделено антиагрегантам и антикоагулянтам. Обсуждены результаты наиболее значимых рандомизированных клинических исследований, в которых оценивалась эффективность и безопасность применения препаратов этих классов в терапии хронической ИБС. Подробно рассмотрены результаты исследования COMPASS, в котором получено подтверждение положительного влияния на прогноз пациентов с хронической ИБС или заболеванием периферических артерий комбинированной терапии ривароксабаном и ацетилсалициловой кислотой. Обсуждены аспекты безопасности этой терапии. Определена позиция ривароксабана в лечении больных хронической ИБС с синусовым ритмом согласно рекомендациям Европейского общества кардиологов по диагностике и лечению хронической ИБС 2019 г.

хроническая ишемическая болезнь сердцапрогнозэффективность и безопасность терапииантиагрегантыривароксабанchronic ischemic heart diseaseprognosisefficacy and safety of therapyantiplatelet agentsrivaroxabanReferencesMontalescot G., Sechtem U., Achenbach S., et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34(38):2949-3003. DOI:10.1093/eurheartj/eht296.Montalescot G., Sechtem U., Achenbach S., et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34(38):2949-3003. DOI:10.1093/eurheartj/eht296.Steg P.G., Bhatt D.L., Wilson P.W., et al. One-Year cardiovascular event rates in outpatients with atherothrombosis. JAMA. 2007;297:1197-206. DOI:10.1001/jama.297.11.1197.Steg P.G., Bhatt D.L., Wilson P.W., et al. One-Year cardiovascular event rates in outpatients with atherothrombosis. JAMA. 2007;297:1197-206. DOI:10.1001/jama.297.11.1197.Knuuti J., Wijns W., Saraste A., et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J. 2019;00:1-71. DOI:10.1093/eurheartj/ehz425.Knuuti J., Wijns W., Saraste A., et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J. 2019;00:1-71. DOI:10.1093/eurheartj/ehz425.Vidal-Petiot E., Ford I., Greenlaw N., et al.; CLARIFY Investigators. Cardiovascular event rates and mortality according to achieved systolic and diastolic blood pressure in patients with stable coronary artery disease: an international cohort study. Lancet. 2016;388(10056):2142-2152. DOI:10.1016/S0140-6736(16)31326-5.Vidal-Petiot E., Ford I., Greenlaw N., et al.; CLARIFY Investigators. Cardiovascular event rates and mortality according to achieved systolic and diastolic blood pressure in patients with stable coronary artery disease: an international cohort study. Lancet. 2016;388(10056):2142-2152. DOI:10.1016/S0140-6736(16)31326-5.Williams B., Mancia G., Spiering W., et al. 2018 ESC/ESH 2013 ESC guidelines for the management of arterial hypertension: the Task Force on the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J. 2018;00:198. DOI:10.1093/eurheartj/ehy339.Williams B., Mancia G., Spiering W., et al. 2018 ESC/ESH 2013 ESC guidelines for the management of arterial hypertension: the Task Force on the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J. 2018;00:198. DOI:10.1093/eurheartj/ehy339.Mach F., Baigent C., Catapano A.L., et al. 2019 ESC/ESH 2013 ESC guidelines for the management of dislipidaemias: lipid modification to reduce cardiovascular risk. The Task Force on the management of dislipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J. 2019;00:1-78. DOI:10.1093/eurheartj/ehz445.Mach F., Baigent C., Catapano A.L., et al. 2019 ESC/ESH 2013 ESC guidelines for the management of dislipidaemias: lipid modification to reduce cardiovascular risk. The Task Force on the management of dislipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J. 2019;00:1-78. DOI:10.1093/eurheartj/ehz445.Neumann F.J., Sousa-Uva M., Ahliston A., et al. 2018 ESC/EACT Guidelines on myocardial revascularization: The Task Force on myocardial revascularization myocardial revascularization myocardial revascularization of the European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association for Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2018;00:1-96. DOI:10.1093/eurheartj/ehy394.Neumann F.J., Sousa-Uva M., Ahliston A., et al. 2018 ESC/EACT Guidelines on myocardial revascularization: The Task Force on myocardial revascularization myocardial revascularization myocardial revascularization of the European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association for Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2018;00:1-96. DOI:10.1093/eurheartj/ehy394.Antithrombotic Trialists’ Collaboration Collaborative meta-analysis of randomised trials of antiplatelet therapy for the prevention of death, myocardial infarction and stroke in high risk patients. BMJ. 2002;324:71-86. DOI:10.1136/bmj.324.7329.71.Antithrombotic Trialists’ Collaboration Collaborative meta-analysis of randomised trials of antiplatelet therapy for the prevention of death, myocardial infarction and stroke in high risk patients. BMJ. 2002;324:71-86. DOI:10.1136/bmj.324.7329.71.Antithrombotic Trialists’ Collaboration, Baigent C., Blackwell L., Collins R., et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet. 2009;373:1849-60. DOI:10.1016/S0140-6736(09)60503-1.Antithrombotic Trialists’ Collaboration, Baigent C., Blackwell L., Collins R., et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet. 2009;373:1849-60. DOI:10.1016/S0140-6736(09)60503-1.CAPRIE Steering Committee. A randomised, blinded trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet. 1996;348:1329-1339. DOI:10.1016/S01406736(96)09457-3.CAPRIE Steering Committee. A randomised, blinded trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet. 1996;348:1329-1339. DOI:10.1016/S01406736(96)09457-3.Schmit K., Dolor R.J., Jones W.S., et al. Comparative effectiveness review of antiplatelet agents in peripheral artery disease. J Am Heart Assoc. 2014;3:e001330. DOI:10.1161/JAHA.113.001330.Schmit K., Dolor R.J., Jones W.S., et al. Comparative effectiveness review of antiplatelet agents in peripheral artery disease. J Am Heart Assoc. 2014;3:e001330. DOI:10.1161/JAHA.113.001330.Belch J.J., Dormandy J., Biasi G.M., et al. Results of the randomized, placebo-controlled clopidogrel and acetylsalicylic acid in bypass surgery for peripheral arterial disease (CASPAR) trial. J Vasc Surg. 2010;52:825-33. DOI:10.1016/j.jvs.2010.04.027.Belch J.J., Dormandy J., Biasi G.M., et al. Results of the randomized, placebo-controlled clopidogrel and acetylsalicylic acid in bypass surgery for peripheral arterial disease (CASPAR) trial. J Vasc Surg. 2010;52:825-33. DOI:10.1016/j.jvs.2010.04.027.Piepoli M.F., Hoes A.W., Agewall S., et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016;37:2315-81. DOI:10.1093/eurheartj/ehw106.Piepoli M.F., Hoes A.W., Agewall S., et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016;37:2315-81. DOI:10.1093/eurheartj/ehw106.Aboyans V., Ricco J.B., Bartelink M.E.L. et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS) Eur Heart J. 2017;00:1-60. DOI:10.1093/eurheartj/ehx095.Aboyans V., Ricco J.B., Bartelink M.E.L. et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS) Eur Heart J. 2017;00:1-60. DOI:10.1093/eurheartj/ehx095.Roffi M., Patrono C., Collet J.P., et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37:267-315. DOI:10/1093/eurheartj/ehv320.Roffi M., Patrono C., Collet J.P., et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37:267-315. DOI:10/1093/eurheartj/ehv320.Ibanez B., James S., Agewall S., et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2017;00:1-66. DOI:10.1093/eurheartj/ehx393.Ibanez B., James S., Agewall S., et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2017;00:1-66. DOI:10.1093/eurheartj/ehx393.Bonaca M.P., Bhatt D.L., Cohen M., et al. Long-term use of ticagrelor in patients with prior myocardial infarction. N Engl J Med. 2015;372(19):1791-800. DOI:10.1056/NEJMoa1500857.Bonaca M.P., Bhatt D.L., Cohen M., et al. Long-term use of ticagrelor in patients with prior myocardial infarction. N Engl J Med. 2015;372(19):1791-800. DOI:10.1056/NEJMoa1500857.Valgimigli M., Bueno H., Byrne R.A., et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. Eur Heart J. 2017;00:1-48. DOI:10.1093/eurheartj/ehx419.Valgimigli M., Bueno H., Byrne R.A., et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS. Eur Heart J. 2017;00:1-48. DOI:10.1093/eurheartj/ehx419.Bhatt D.L., Flather M.D., Hacke W., et al. Patients with prior myocardial infarction, stroke, or symptomatic peripheral arterial disease in the CHARISMA trial. J Am Coll Cardiol. 2007;49:1982-8. DOI:10.1016/j.jacc.2007.03.025.Bhatt D.L., Flather M.D., Hacke W., et al. Patients with prior myocardial infarction, stroke, or symptomatic peripheral arterial disease in the CHARISMA trial. J Am Coll Cardiol. 2007;49:1982-8. DOI:10.1016/j.jacc.2007.03.025.Bhatt D.L., Fox K.A., Hacke W., et al. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med. 2006;354:1706-17. DOI:10.1056/NEJMoa060989.Bhatt D.L., Fox K.A., Hacke W., et al. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med. 2006;354:1706-17. DOI:10.1056/NEJMoa060989.Morrow D.A., Braunwald E., Bonaca M.P., et al. Vorapaxar in the secondary prevention of atherothrombotic events. N Engl J Med. 2012; 366: 1404-13. DOI:10.1056/NEJMoa1200933.Morrow D.A., Braunwald E., Bonaca M.P., et al. Vorapaxar in the secondary prevention of atherothrombotic events. N Engl J Med. 2012; 366: 1404-13. DOI:10.1056/NEJMoa1200933.Mega J.L., Braunwald E., Wiviott S.D., et al. Rivaroxaban in Patients with a Recent Acute Coronary Syndrome. N Engl J Med. 2012;366(1):9-19. DOI:10.1056/NEJMoa1112277.Mega J.L., Braunwald E., Wiviott S.D., et al. Rivaroxaban in Patients with a Recent Acute Coronary Syndrome. N Engl J Med. 2012;366(1):9-19. DOI:10.1056/NEJMoa1112277.Eikelboom J.W., Connolly S.J., Bosch J., et al. COMPASS Investigators. Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease. N Engl J Med. 2017;377(14):1319-30. DOI:10.1056/NEJMoa1709118.Eikelboom J.W., Connolly S.J., Bosch J., et al. COMPASS Investigators. Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease. N Engl J Med. 2017;377(14):1319-30. DOI:10.1056/NEJMoa1709118.Connolly S.J., Eikelboom J.W., Bosch J., et al. COMPASS investigators. Rivaroxaban with or without aspirin in patients with stable coronary artery disease: an international, randomised, double-blind, placebo-controlled trial. Lancet. 2018;391(10117):205-18. DOI:10.1056/S0140-6736(17)32458-3.Connolly S.J., Eikelboom J.W., Bosch J., et al. COMPASS investigators. Rivaroxaban with or without aspirin in patients with stable coronary artery disease: an international, randomised, double-blind, placebo-controlled trial. Lancet. 2018;391(10117):205-18. DOI:10.1056/S0140-6736(17)32458-3.

The authors declare that there are no conflicts of interest present.