In-hospital therapy for myocardial infarction in the Russian Federation according to the REGION-IM registry: compliance with clinical guidelines

Objective. To analyze the features of in-hospital drug therapy in patients with myocardial infarction in the Russian Federation considering the REGION-IM register data, to assess the compliance of therapy with current clinical guidelines. Material and methods. REGION-IM (Russian Registry of Acute Myocardial Infarction) is a multiple-center prospective observational study including 10.884 patients (7.631 with ST-segment elevation myocardial infarction (STEMI) and 3.253 without ST-segment elevation (NSTEMI)). Data on in-hospital drug therapy were obtained from 10.568 patients. Results. Acetylsalicylic acid was prescribed in 94% of patients, dual antiplatelet therapy — 93%, clopidogrel — 57%, ticagrelor — 41% of patients. Prasugrel was prescribed in only 32 patients. Only 9.7% of patients received triple antithrombotic therapy (combination of oral anticoagulant with acetylsalicylic acid and P2Y12 inhibitor). Parenteral anticoagulants were prescribed in 74.2% of patients with STEMI and 73% of patients with NSTEMI. The most common drug regardless of MI type and reperfusion strategy was unfractionated heparin, the second most common drug — enoxaparin. Fondaparinux was prescribed in only 1.9% of STEMI patients in the conservative treatment group and 8.2% of all patients with NSTEMI. Statins were prescribed in 96% of patients, ezetemibe — in 46 (0.44%) patients, fenofibrate — 0.02%. No PCSK9 receptor inhibitors were prescribed in the hospital. Beta-blockers were prescribed in 91.8% of patients, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers — 76% and 9%, respectively. Conclusion. According to the REGION-IM register, there is a high frequency of prescription of all drugs with clear effectiveness. However, there is a space for more frequent prescription of more powerful and effective P2Y12 inhibitors (ticagrelor and prasugrel), parenteral anticoagulants with clear benefits (enoxaparin and fondaparinux). Early ezetemibe and/or PCSK9 inhibitors should be considered in patients with severe hypercholesterolemia despite statin therapy or if low efficacy of statin monotherapy for target level of cholesterol is clear.