TY  -  JOUR
AU  -  Del Pinto, Maurizio
AU  -  Santucci, Andrea
AU  -  Guarnaccia, Franco
AU  -  Tutarini, Cristina
AU  -  Musto, Carmine
T1  -  Il registro OIBOH (Optimal Intensification therapy 
in a Broad Observed High risk patient population 
with coronary disease): studio italiano osservazionale di prevenzione secondaria dopo evento coronarico 
durante la pandemia COVID-19
PY  -  2022
Y1  -  2022-02-01
DO  -  10.1714/3750.37329
JO  -  Giornale Italiano di Cardiologia
JA  -  G Ital Cardiol
VL  -  23
IS  -  2
SP  -  3
EP  -  14
PB  -  Il Pensiero Scientifico Editore
SN  -  1972-6481
Y2  -  2026/07/26
UR  -  http://dx.doi.org/10.1714/3750.37329
N2  -  Background. In Italy, the COVID-19 outbreak has had a dramatic impact on clinical healthcare in both the in-hospital and ambulatory setting. This has been a relevant issue among clinicians and public policy makers in order to improve organization in various clinical scenarios.Methods. The OIBOH (Optimal Intensification therapy in a Broad Observed High risk patient population with coronary disease) registry is a cross-sectional study, designed to evaluate ambulatory cardiologists’ capability in identifying very high-risk patients after a recent coronary event (<12 months). After initial clinical evaluation of a very high-risk patient at ambulatory visit, baseline clinical characteristics and treatment were recorded in an electronic database.Results. In 134 ambulatory centers, 1428 patients were enrolled among 3227 all-comers screened for coronary disease from October 2020 to March 2021. Enrolled patients had to be diagnosed with acute (ACS) or chronic coronary syndrome (CCS) on coronary angiography during the last 12 months. ACS as index event was recorded in 93% of patients whereas CCS in 7%. Mean age was 67 ± 10 years, 25% were female. Coronary revascularization was performed in 96.1% of ACS patients and 67.6% of CCS patients. Diabetes was present in 46% and 47% of ACS and CCS patients, respectively. More than 65% of patients suffered from multivessel disease. A high prevalence of peripheral artery disease was recorded (17.5% in ACS patients and 19.6% in CCS patients). Blood pressure and heart rate were well controlled (128 ± 25.2 mmHg and 65 ± 12.3 bpm in ACS patients; 127 ± 23.4 mmHg and 67 ± 13.2 bpm in CCS patients). In contrast, LDL-cholesterol was not appropriately controlled, with mean values of 88.8 ± 38.6 mg/dl and 86 ± 36.6 mg/dl in ACS and CCS patients, respectively. Only 16.4% of ACS patients reached the guideline-recommended target levels of LDL-cholesterol. Despite the large use of statin therapy (>90% of patients), high-intensity statin therapy either alone or in association with ezetimibe was underprescribed (55.6% and 22.4%, respectively, in ACS patients). Use of PCSK9 inhibitors was remarkably low (2.5%). In patients receiving dual antiplatelet therapy (DAPT), ticagrelor 90 mg was the most commonly used agent in association with aspirin, particularly in ACS patients (80%). In the vast majority of very high-risk patients (>90%), prolonged DAPT beyond 12 months with low-dose ticagrelor 60 mg bid was prescribed. Conclusions. Long-term management of coronary artery disease patients is complex, especially during the COVID-19 pandemic. The OIBOH registry has highlighted a high capability of ambulatory cardiologists to identify very high-risk patients that could benefit from extended DAPT with ticagrelor 60 mg bid, though more intense LDL-cholesterol lowering should be pursued. In the near future, digital medicine and artificial intelligence may help clinicians to optimize their performance.
ER  -