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Læknablaðið - 15.09.1999, Side 31

Læknablaðið - 15.09.1999, Side 31
LÆKNABLAÐIÐ 1999; 85 697 Aðalveikleiki þessarar rannsóknar er aftur- skyggnt snið hennar. Vegna þessa er notkun lyfja eftir innlögn ekki tilviljunarkennd heldur háð mati mismunandi lækna á ástandi sjúklings hverju sinni. Þannig gætu þeir sem veikastir eru hafa fengið aðra meðferð en þeir sem hafa minni einkenni. Skráning áhættuþátta gæti einnig verið nákvæmari hjá minna veikum sjúklingum þar sem lengri tími gefst til viðtals og skoðunar. Þá vantar heildarfjölda þeirra sem deyja af völdum kransæðastíflu á upptöku- svæði spítalanna og á landinu öllu svo hægt sé að meta heildardánarhlutafall kransæðastíflu. Ymsum grundvallarspurningum um áhrif breyttrar meðferðar kransæðastíflu á horfur hefur verið svarað með þessari rannsókn. Margt er þó enn óþekkt. Ahrif áhættuþátta á horfur sjúklinga með kransæðastíflu hafa ekki verið rannsökuð á framskyggnan máta en tíðni áhættuþátta hjá íslenskum hjartasjúklingum og áhrif þeirra á uppkomu kransæðasjúkdóms meðal íslendinga er þekkt úr rannsóknum Hjartaverndar. Þakkir Eftirtöldum aðilum er þakkað: Guðmundi Oddssyni yfirlækni hjartadeildar Sjúkrahúss Reykjavíkur, Arna Kristinssyni yfirlækni hjartadeildar Landspítalans, Nikulási Sigfús- syni, Ugga Agnarssyni og Helga Sigvaldasyni hjá Hjartavernd, starfsfólki skjalasafna og tölvudeilda Sjúkrahúss Reykjavíkur og Land- spítalans og læknariturum lyflækningadeildar Sjúkrahúss Reykjavíkur. Rannsóknin var styrkt með framlagi úr Vísindasjóði Borgarspítalans. HEIMILDIR 1. Second Intemational Study on Infarct Survival Collabor- ative Group. Randomised trial of intravenous streptokinasi, oral aspirin, both or neither among 17187 cases of suspec- ted myocardial infarction. ISIS-2. Lancet 1988; 336: 827- 30. 2. The RISC Group. Risk of myocardial infarction and death during treatment with low dose aspirin and intravenous heparin in men with unstable coronary artery disease. Lancet 1990; 336: 827-30. 3. First Intemational Study on Survival Collaborative Group. Randomised trial of intravenous atenolol among 16027 cases of suspected acute myocardial infarction: ISIS-1. Lancet 1986; 2: 57-66. 4. The MIAMI trial research group. Metoprolol in acute myo- cardial infarction (MIAMI). Eur Heart J 1985; 5: 199-226. 5. Gmppo italiani per lo studio della streptochinase nell’ infarcto myocardico (GISSI): Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet 1986; I: 397-401. 6. The GUSTO investigators. An intemational randomised trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med 1993; 329: 673-82. 7. CONSENSUS Trial Study Group. Effect of enalapril on mortality in severe congestive heart failure. Results of the cooperative North-Scandinavian enalapril survival study (CONSENSUS). N Engl J Med 1987; 316: 678-84. 8. The Acute Infarction Ramipril Efficiacy (AIRE) study in- vestigators. Effects of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet 1993; 342: 821-8. 9. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 344: 1383-9. 10. Buring JE, Glynn RJ, Hennekens CH. Calcium channel blockers and acute myocardial infarction: a hypothesis formulated but not yet tested. JAMA 1995; 274: 654-5. 11. Davies RF, Goldberg AD, Forman S, Pepine CJ, Knattemd GL, Geller N, et al. Asymptomatic Cardiac Ischemia Pilot (ACIP) Study Two-Year Follow-up: Outcomes of Patients Randomized to Initial Strategies of Medical Therapy Versus Revascularization. Circulation 1997; 95: 2037-43. 12. GUSTO-IIb Angioplasty Substudy Investigators. A clinical trial comparing primary angioplasty with tissue plasmino- gen activator for acute myocardial infarction. N Engl J Med 1997; 336: 1621-8. 13. Grines CL, Browne KF, Marco J, Rothbaum D, Stone GW, O’Keefe J, et al. The Primary Angioplasty in Myocardial Infarction Study Group. A comparison of immediate angioplasty with thrombolytic therapy for myocardial infarction. N Engl J Med 1993; 328: 673-9. 14. Agnarsson U, Sigfússon N, Guðmundsdóttir II, Stefáns- dóttir I. Bráð kransæðastífla á íslandi 1982-1986. Lækna- blaðið 1996; 82: 276-85. 15. Chambless L, Keil U, Dobson A, Mahonen M, Kuulasmaa K, Rajakangas AM, et al. Population versus clinical view of case mortality from acute coronary heart disease: results from the WHO MONICA Project 1985-1990. Multinational MONItoring of trends and Determinants in Cardiovascular Disease. Circulation 1997; 96: 3849-59. 16. Salomaa VV, Lundberg V, Agnarsson U, Radisauskas R, Kirchhoff M, Wilhelmsen L. Fatalities from myocardial infarction in Nordic countries and Lithuania. The MONICA Investigators. Eur Heart J 1997; 18: 91-8. 17. Bjömsdóttir US, Thorlacius S, Jónsson Á, Lárusson G. Kransæðastífla á Landakotsspítala 1981-1985. Læknablað- ið 1988; 74: 241-3. 18. McGovem PG, Herlitz J, Pankow JS, Karlsson T, Dellborg M, Shahar E, et al. Comparison of medical care and 12 month mortality of hospitalised patient with acute myo- cardial infarction in Minneapolis/St. Paul, Minnesota, United States of America and Göteborg Sweden. Am J Cardiol 1997; 80: 557-62. 19. Jónsson JJ, Óskarsson H, Þorgeirsson Gu, Þorgeirsson Ge, Eyjólfsson Ó, Harðarson Þ. Segaleysandi meðferð við bráðri kransæðastíflu. Árangur meðferðar hjá fyrstu þrjátfu og þremur íslensku sjúklingunum. Læknablaðið 1986; 72: 191-8. 20. Sigfússon N, Sigvaldason H, Steingrimsdóttir L, Guð- mundsdóttir II, Stefánsdóttir I, Thorsteinsson TH, et al. Decline in ischemic heart disease in Iceland and change in risk factor levels. BMJ 1991; 302: 1371-5. 21. Madsen JK, Pedersen F, Nielsen H, Jensen GV, Hansen JF. Improved long term prognosis in elderly patients with acute myocardial infarction after the introduction of intravenous thrombolytic therapy. Scand Cardiovasc J 1998; 32: 365- 70. 22. Gottlieb SS, McCarter RJ, Vogel RA. Effect of Beta-Blockade on Mortality among High-Risk and Low-Risk Patient after Myocardial Infarction. N Engl J Med 1998; 339:489-97. 23. Buring JE, Glynn RJ, Hennekens CH. Calcium channel blockers and acute myocardial infarction: a hypothesis formulated but not yet tested. JAMA 1995; 274: 654-5. 24. Sigurðsson EL, Jónsson JS, Þorgeirsson G. Hvemig er kól-
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