Frumárangur kransæðavíkkana hjá sjúklingum með sykursýki á Íslandi
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Issue Date
2004-03-01
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Percutaneous coronary intervention in icelandic diabetic patientsCitation
Læknablaðið 2004, 90(3):227-232Abstract
Introduction: Several studies suggest that the primary success of percutaneous coronary intervention (PCI) is less in diabetic patients than others and that complications and restenosis are more frequent. This was therefore assessed in icelandic diabetic patients. Methods: From 1987 to 2002 a total of 4435 PCI s were performed and of these 377 (8.5%) were in diabetic patients. The clinical background of the patients, primary success after PCI, and in-hospital complications, were retrospectively assessed. Results: The relative frequency of diabetics undergoing PCI increased significantly during the study period from 5.7% to 10.6% (p=0.001). In diabetic compared with non-diabetic patients, the mean age was higher (64 +/- 10 versus 62 +/- 10 years; p=0.002), and women were more frequent. Hypertension and hypercholesterolaemia were more common in the diabetics and a larger proportion of them were current smokers. Further more, diabetics more frequently had a previous history of myocardial infarction, coronary artery bypass surgery, PCI, unstable angina and triple-vessel disease. The overall use of stents was similar in the groups, as was PCI for clinical restenosis (13.3% versus 10.8%; p=0.15). The primary success rate was comparable in diabetics and non-diabetics (93% versus 92%). The need for acute coronary bypass post-PCI was similar in the groups, whereas diabetics more rarely had a three fold increase in creatinine kinase-MB values. Overall, in-hospital mortality was low (0.4%), but higher in diabetic than non-diabetic patients (1.1% versus 0.3%; p=0.04). By multivariate analysis, significant independent predictors of in-hospital mortality were: Primary PCI for acute ST-elevation infarction, number of stenotic coronary vessels, diabetes and age, while the presence of hypercholesterolemia was an inverse predictor. Conclusion: The primary success rate for PCI is comparable in icelandic diabetic and non-diabetic patients. Although few patients died in hospital after PCI, the diabetic patients did have a higher in-hospital mortality rate.Inngangur: Erlendar rannsóknir benda til þess að frumárangur kransæðavíkkana sé lakari hjá sykursjúkum en öðrum kransæðasjúklingum og fylgikvillar og endurþrengsli algengari. Því var gerður samanburður á þessu hér á landi. Efniviður og aðferðir: Á árunum 1987-2002 voru gerðar 4435 kransæðavíkkanir, þar af 377 (8,5%) hjá sykursjúkum. Sjúkraskrár voru kannaðar afturvirkt með tilliti til klínískra þátta, frumárangurs kransæðavíkkunar, og fylgikvilla á sjúkrahúsi. Niðurstöður: Hlutfallsleg tíðni sykursjúkra sem fóru í kransæðavíkkun jókst á rannsóknartímabilinu úr 5,7% í 10,6% (p=0,001). Hjá sykursjúkum í samanburði við sjúklinga án sykursýki var meðalaldur hærri (64 ± 10 á móti 62 ±10 ár; p=0,002) og konur voru hlutfallslega fleiri. Meðal sykursjúkra var tíðni háþrýstings, hækkaðs kólesteróls og virkrar reyktóbaksfíknar hærri. Algengara var að sykursjúkir hefðu fyrri sögu um hjartadrep, opna hjáveituaðgerð, kransæðavíkkun, hvikula hjartaöng og þriggjaæða sjúkdóm. Klínísk endurþrengsli sem aftur þurftu víkkunaraðgerð voru ekki marktækt algengari hjá sjúklingum með sykursýki í samanburði við aðra (13,3% á móti 10,8%; p= 0,15). Frumárangur kransæðavíkkana var jafn góður hjá sjúklingum með og án sykursýki (93% á móti 92%). Þörf á bráðri hjáveituaðgerð eftir víkkun var sambærileg hjá hópunum, en meðal sykursjúkra var meira en þreföld hækkun á kreatínínkínasa-MB fátíðari. Hins vegar var dánartíðni í sjúkrahúslegu marktækt hærri hjá sykursjúkum en öðrum (1,1% á móti 0,3%; p=0,04). Í fjölþáttagreiningu voru marktækir spáþættir fyrir dauða í sjúkrahúslegu: Bráð kransæðavíkkun vegna ST-hækkunar hjartadreps, fjöldi þrengdra kransæða, sykursýki og aldur, en greind kólesterólhækkun var verndandi þáttur. Ályktun: Frumárangur kransæðavíkkana hér á landi er sambærilegur hjá sjúklingum með og án sykursýki. Fáir sjúklingar létust í kjölfar kransæðavíkkunar, en hjá sykursjúkum var dánartíðni í sjúkrahúslegu þó hærri en hjá öðrum sjúklingum
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