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CNAA / Theses / 2008 / June /

Variants of clinical evolution and prognosisi of patients with ischemic heart disease after non-ST elevation acute coronary event

Author: Liliana Căldare
Degree:doctor of medicine
Speciality: 14.00.06 - Cardiology and Reumatology
Scientific adviser: Aurel Grosu
doctor habilitat, professor, Medical-Sanitary Public Institution Institute of Cardiology
Scientific council:


The thesis was presented on the 10 June, 2008
Approved by NCAA on the 18 September, 2008


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147 pages


non-ST elevation acute coronary syndrome, risk factors, risk scores, PURSUIT score, prognosis, long-term follow-up, cardiac death


In this study were included 367 patients with non-ST elevation acute coronary syndrome, the middle age 650,5 years. These patients has a lot of risk factors as hypertension, diabetes mellitus, obesity, smoking. Most of them were hospitalized urgently because of ischemic chest pain. The ECG made at admission shown ST-segment depression, T wave inversion and their association. EcoCG exam fixed a preserved ejection fraction in spite of motility abnormalities in 59% of cases. The biochemistry examination indicated increased level of total cholesterol, LDL-cholesterol and glucose.

During the follow-up 237 (64,5%) patients survived, 80 (21,8%) died and 45 (19%) were lost. In this period 56,5% of survived patients was hospitalized because of cardiac symptoms exacerbation, 13,3% were expected myocardial infarction. The biochemistry evaluation of lipid and glucose profile didn’t demonstrate the reaching goals of secondary cardiovascular diseases prevention. The indicated treatment at discharge and the administrated treatment during the follow-up was similar except the reduced use of beta-blockers agents (84,4% vs 61,4%).

In base of statistical analysis were identified the factors correlated with death during the follow-up – aortal stenosis, the presence and the degree of ST segment depression, the repeated chest pain at admission, EF bellow 40%, lack of beta-blockers and aspirin use during hospitalisation, the admission diagnosis of instable angina, T wave presence at discharge, past heart failure and III Killip class. The dead patients had a higher PURSUIT score and they belonged to a high risk group.