NEWS
Einthoven Dissertation Prizes
2004
For the sixteenth time in a row, the Netherlands Society of Cardiology (NVVC), the Interuniversity Cardiology Institute ofthe Netherlands (ICIN), and the sponsor, Sanofi-Aventis, have supported the competition for the best three PhD theses on a cardiovascular subject published last year. The prize carries the name of one of the great men in the history of cardiology: Wlllem Einthoven (1860-1927), the pioneer of the human ECG. The jury, consisting of representatives of the NVVC, the ICIN, and Sanofi Aventis, reviewed a total of 18 dissertations. The jury members were impressed and pleased by the scientific quality of the work of the young doctors. As always, it was not easy to decide which ones to nominate for the final round. The three nominees will present their work at the spring meeting ofthe NVVC, which will be held in Amsterdam on 22 April 2005. The ultimate winner of the first, second and third prize will be chosen by the audience. Summaries of the three nominated PhD theses are given below.
Professor C.A. Visser Chairman of the Jury
Antithrombotic strategies and the impact of coronary reoccluslon In ST-elevation myocardlal Infarction Achieving early and sustained coronary patency forms the cornerstone in the treatment of ST-elevation myocardial infarction (STEMI). Cumulative evidence shows that primary percutaneous coronary intervention (PCI) is the optimal reperfusion strategy, but despite improved logistics and availability many patients are still treated with fibrinolysis. This thesis addresses three important aspects of pharmacological reperfusion therapy: 1. Timely administration of fibrinolysis; 2. The risk of reocclusion and recurrent events, and; 3. The prognostic impact ofsustained coronary patency. 1. In the MITI trial patients with STEMI in the Seattle metropolitan area (Washington, USA) were randomised to prehospital or in-hospital fibrinolysis. Early treatment was associated with reduced infarct size, better left ventricular function and lower mortality. Long-term survival was significantly higher until two years of follow-up, after which the difference dissipated. Meta-analyses have shown that prehospital fibrinolysis saves 58 minutes and about 16 to 18 lives per 1000 patients treated. This benefit is in the same order of magnitude as observed for primary PCI versus in-hospital fibrinolysis. 2. When fibrinolysis is successful, the prognosis is good, but recurrent ischaemic events are frequent, often attributed to reocclusion. Despite the use of aspirin, reocclusion is observed in 5 to 10% of patients at the time of discharge, and in 25% within three months. In search of better antithrombotics during admission, agents as enoxaparin and pentasaccharide were often reported to be superior to unfractionated heparin due to a more potent antithrombotic effect. In fact, the new agents were administered two to three days longer than un-
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Netherlands Hcart Journal, Volume 13, Number 5, May 2005
fractionated heparin, which precludes conclusions regarding the mechanism of benefit. In order to reduce long-term reocclusion rates, APRICOT-2 studied the impact of prolonged anticoagulation therapy. Patients with an open infarct artery after fibrinolysis were randomised to either 48 hours of heparin and the indefinite use of aspirin, or to a prolonged anticoagulation strategy. In this arm patients received aspirin and a three-month strategy of coumadin was started, with continuation of heparin until the target INR (2-3). Reocclusion rates at three months were significantly lower in patients on aspirin and coumadin: 28 vs. 15% (RR 0.55, 95% CI 0.33-0.90, p