Læknablaðið - 15.03.1997, Blaðsíða 37

LÆKNABLAÐIÐ 1997; 83
169
Nýr doktor í læknisfræði
Þann 17. janúar síðastliðinn varði Karl And-
ersen doktorsritgerð við Háskólann í Gauta-
borg. Ritgerðin nefnist Vectorcardiographic
ST-segment monitoring in the unstablc coro-
nary syndrome. Ágrip úr ritgerðinni fer hér á
eftir.
Patients hospitalized for unstable coronary
syndromes are a heterogeneous group with
varying degrees of ischaemia and prognosis.
Several methods have been proposed for risk
stratification of these patients. In the present
study, 568 patients admitted to coronary care
units for unstable coronary disease were mon-
itored by 24 hour continuous vectorcardio-
graphy in order to investigate the prognostic
significance of ischaemic episodes and their
relation to clinical efficacy.
The prognostic value of baseline character-
istics, clinical risk evaluation at hospital admis-
sion, vectorcardiographic and biohemical
markers of risk were studied in 195 patients. At
one year of follow-up 14% of the patients had
died or suffered a nonfatal infarction. Clinical
risk evaluation correctly identified a popula-
tion at low risk but did not otherwise predict
outcome. Both vectorcardiographic and bio-
chemical risk markers identified high risk
groups.
In the same patient group, several baseline
characteristics, vectorcardiographic and bio-
chemical markers of risk were compared in a
multivariate analysis. Of 22 variables studied,
only ST-VM episodes on vectorcardiochrapic
monitoring independently predicted death,
death or nonfatal infarction, and death, non-
fatal infarction or unstable angina up to one
year follow-up or revascularization before hos-
pital discharge.
The prognostic value of continuous ST-seg-
ment monitoring was compared to that of bio-
chemical monitoring at 7 days of follow-up in a
multicentre study of 215 patients. The compos-
ite end point of death, nonfatal infarction or
refractory angina was reached by 7.4% of the
patients. In a multivariate analysis of 11 base-
line and clinical risk markers, only ST-VM epi-
sodes independently predicted death or non-
fatal infarction, while both ST-VM episodes
and ST-segment depression on the admission
ECG were independent predictors of death,
nonfatal infarction or refractory angina at 7
days of follow-up.
In an open-label study, 47 patients with un-
stable angina or non-Q-wave infarction were
treated with inogatran, a novel low molecular
weight thrombin inhibitor. Markers of throm-
bin activity and vectorcardiographic signs of
ischaemia increased during the 4 hours imme-
diately following a 4 hour drug infusion. Re-
bound ischaemia after cessation of short-term
treatment with thrombin inhibitors was vali-
dated by comparing electrocardiographic and
humoral markers of thrombin activity.