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182 J KARDIOL 2008; 15 (5–6)

ÖKG-Jahrestagung – Abstracts

Bei den Implantaten mit Möglichkeit der automatischen Ereignis-

meldung (z. B. AF/AT-Episoden, Schocks, ERI, Optivol, Elektro-

denwarnung) wurden 33 Ereignisse registriert.

Abhängig von der Ereignisart erfolgte eine telefonische Kontakt-

aufnahme mit dem Patienten bzw. wurde eine vorzeitige ambulante

Begutachtung vereinbart. In den meisten Fällen (92 %) waren aller-

dings keine weiteren Schritte erforderlich.

Alle 71 Patienten, die zumindest eine telemedizinische Kontrolle

hatten, empfinden die Benutzung des Monitors als leicht oder sehr

leicht. 37 von 71 Patienten (52 %) gaben an, dass ihr Sicherheits-

gefühl gesteigert bzw. stark gesteigert wurde, 48 % fühlten keine

Änderung, kein Patient (0 %) gab an, ein reduziertes oder stark re-

duziertes Sicherheitsgefühl zu haben. 70 von 71 Patienten (99 %)

bevorzugen die telemedizinische gegenüber der konventionellen

Nachsorge.

Als wichtigste Vorteile dieser Methode gaben die Patienten an:

Zeitersparnis (69 %), nicht an Krankenhaustermin gebunden sein

(69 %), rasche Kontrollmöglichkeit bei Problemen (68 %), Sicher-

heit (58 %), Kostenersparnis (49 %). 70 von 71 Patienten (99 %)

würden die Monitor-Nachsorge anderen Patienten weiterempfeh-

len.

Konklusion Die Patientenakzeptanz für die telemedizinische

Nachsorge von ICD-Patienten mit dem Medtronic CareLink-Sys-

tem ist sehr hoch. Die Patienten schätzen vor allem die einfache und

zeitsparende Möglichkeit der ICD-Fernnachsorge, weiters das bei

den meisten gesteigerte Gefühl der Sicherheit.

Anhand der telemedizinischen Nachsorge bzw. des Monitorings im

Falle auftretender Ereignisse über das CareLink-System kann eine

Verbesserung der Qualität und der Sicherheit der Patientenbetreu-

ung sowie eine Verbesserung der Prävention und Individualisierung

der Behandlung erzielt werden.

Short- and Long-term Mortality in Patients with

Non-ST-Segment Elevation Acute Coronary Syn-

drome (NSTE-ACS) 112

B. Vogel, S. Hahne, K. Kalla, R. Jarai, I. Kozanli, M. Nürnberg, A. Geppert,

G. Unger, K. Huber

Med. Dept., Cardiology and Emergency Medicine, Wilhelminenhospital, Vienna

Background and Aim In 2002 updated guidelines recommend

an early invasive and pharmacologically more aggressive therapy in

patients with NSTE-ACS. We aimed to compare the clinical out-

come in consecutive patients admitted to our department before

implementation of the new guidelines (2001–2002) and thereafter

(2003–2004).

Methods In a systematic retrospective review of clinical records

data on 813 patients admitted to our cardiology department for

either unstable angina (UA) or non-ST-segment elevation myo-

cardial infarction (NSTEMI) between January 2001 and December

2004 were analyzed. Data concerning 1- and 2-year mortality were

received either from hospital records in patients regularly controlled

in our outpatients ward or from the Mortality Statistics Austria.

Results In patients with unstable angina (Tn negative) the per-

centage of an invasive strategy increased from 32.0 % before to

63.6 % after implementation of guidelines (p < 0.001). While

23.8 % of patients admitted 2001/2002 received early invasive

therapy within 48 hours, it was 53.7 % of patients admitted 2003/

2004 (p < 0.001). The administration of clopidogrel increased from

34.1 % to 67.2 % (p < 0.001). In-hospital mortality rate was not dif-

ferent between both treatment periods (1.6 % vs 1.6 %; p = 0.967).

After 1 year mortality decreased from 11.7 % to 7.0 % (p = 0.152),

a result which was statistically significant after 2 years (19.4 % vs

7.8 %; p = 0.003), respectively.

In patients with non-ST-segment myocardial infarction (Tn posi-

tive) the rate of interventions increased from 31.8 % to 47.9 %

(p = 0.001). In 2001/2002, 28.6 % of the interventions were per-

formed within 48 hours but reached 51.5 % in 2003/2004 (p =

0.007). Administration of clopidogrel on admission increased

(44.2 % vs 66.2 %; p < 0.001). In-hospital mortality was reduced

from 17.5 % to 9.4 % (p = 0.014) and 1-year mortality decreased

from 33.1 % to 24.5 % (p = 0.057) due to a more aggressive and

early invasive approach. 2-year mortality was still lower in patients

treated in 2003/2004 but did not reach statistical significance any

longer (29.6 % vs. 36.0 %; p = 0.149).

Conclusion The increase of an early invasive and pharmaco-

logically more aggressive therapy in patients with NSTE-ACS led

to beneficial results of short- and long-term mortality in all sub-

groups (Figure 8). Despite a more aggressive treatment (including

early PCI within 48 hours) this therapeutic option, however, is still

withheld in a relatively high number of high-risk patients most obvi-

ously due to an expected increased rate of side effects (e.g. elderly

patients and/or individuals with co-morbidities). According to these

data, more patients of this high-risk group should receive an early

invasive and pharmacologically more aggressive treatment.

Current Cholesterol Guidelines and Clinical Reality:

A Comparison of Coronary Artery Disease Patients

From Now and From Seven Years Ago 029

A. Vonbank, C. H. Saely, C. Boehnel, V. Jankovic, M. Woess, P. Rein, St. Beer,

H. Drexel

VIVIT Institute, Feldkirch

Background Current guidelines recommend serum LDL choles-

terol < 100 mg/dl for patients with stable coronary artery disease

(CAD) and < 70 mg/dl for the very high risk patients with CAD plus

type 2 diabetes (T2DM). We aimed at investing compliance with

these guidelines in two cohorts of CAD patients from now and from

seven years ago.

Methods We obtained lipid panels in two cohort of patients who

were referred to coronary angiography for the evaluation of previ-

ously (> 1 month) established stable CAD in 1999–2000 (n = 49)

and in 2005–2007 (n = 656), respectively.

Results The prevalence of diabetes was 24.9 % in the first and

26.9 % in the second cohort. Overall, 59.3 % and 64.6 % of diabetic

patients and 50.8 % and 58.5 % of non-diabetic patients were on

statins in the first and in the second cohort (p for difference between

the cohorts = 0.408 and 0.043, respectively). Among non-diabetic

patients with CAD, the proportion of subjects with LDL cholesterol

< 100 mg was 23.5 % in the first cohort and 28.9 % in the second

cohort (p = 0.182); among patients with CAD plus T2DM 36.0 %

and 40.6 % (p = 0.481) and 8.1 % and 9.1 % (p = 0.788) had LDL

cholesterol < 100 mg/dl and < 70 mg/dl in the first and in the sec-

ond cohort, respectively.

Figure 8:

B. Vogel et al.

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