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Samanburður á árangri og fylgikvillum kransæðavíkkana hjá konum og körlum

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Authors
Ragnar Danielsen
Kristján Eyjólfsson
Issue Date
2003-10-01

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Other Titles
Percutaneous coronary intervention in women compared with men
Citation
Læknablaðið 2003, 89(10):759-64
Abstract
Introduction: The literature gives contradictory findings as to whether percutaneous coronary intervention (PCI) is equally successful in women and men. The objectives of this study were to compare between the sexes success and complications after PCI in Iceland. Methods: During the years 1987 to 2000 a total of 3355 PCI´s were performed, 798 (24%) in women and 2557 (76%) in men. Detailed records are held for all patients regarding clinical background, the outcome of PCI and in-hospital complications, and these were retrospectively assessed. Results: Compared with men, relatively more women were older than 65 years, hypertensive, hyperlipidemic, and non-smokers, but the prevalence of diabetes was similar. A prior history of myocardial infarction, or thrombolytic therapy was comparable for the sexes, while women less frequently had a history of a previous coronary bypass operation or PCI. Unstable angina pectoris was more common in women, they more often underwent subacute PCI, and were less likely than the men to have 3-vessels disease. PCI on two or more lesions, restenosis, or vein grafts, was comparable in the sexes. The primary success rate for PCI was comparable in women and men (93% versus 91%; p=0.06), and the use of stents was similar. Complications after PCI and in-hospital mortality (0.5% versus 0.3%; NS) was equally frequent, with the exception that women had more groin bleeding at the entry-site (1.25% versus 0.12%; p<0.001) and pseudoaneurysms (2.1% versus 0.6%; p<0.001). Conclusion: The primary success of PCI in Iceland is similar in the sexes. In-hospital mortality is low and complications comparable, with the exception that women more frequently developed entry-site groin sequels than men.
Markmið: Umdeilt er hvort árangur kransæðavíkkana sé jafn góður hjá konum og körlum. Tilgangur þessarar rannsóknar var að bera saman milli kynjanna árangur og fylgikvilla eftir kransæðavíkkunaraðgerð hér á landi. Aðferðir: Á árunum 1987-2000 voru alls gerðar 3355 kransæðavíkkanir, 798 hjá konum (24%) og 2557 hjá körlum (76%). Sjúkraskrár sjúklinga voru kannaðar afturvirkt með tilliti til klínískra þátta í sjúkrasögu, árangurs við kransæðavíkkun og fylgikvilla í sjúkrahúslegu eftir aðgerð. Niðurstöður: Í samanburði við karla voru fleiri konur eldri en 65 ára, með háþrýsting, of háa blóðfitu og án fyrri sögu um reykingar, en tíðni sykur- sýki var svipuð hjá kynjunum. Fyrri saga um hjartadrep og segaleysandi meðferð var sambærileg, en hlutfallslega færri konur höfðu áður farið í opna hjáveituaðgerð eða kransæðavíkkun. Hvikul hjartaöng fyrir aðgerð var algengari hjá konunum, þær fóru oftar hálfbrátt í víkkun og á kransæðamynd voru þær sjaldnar með þriggja æða sjúkdóm en karlar. Kransæðavíkkun á tveim eða fleiri þrengslum, endurþrengslum eða bláæða-græðlingum, var jafn algeng hjá báðum kynjum. Góður víkkunarárangur var svipaður hjá konum og körlum (93% á móti 91%; p=0,06) svo og notkun stoðneta. Fylgikvillar og dánartíðni á sjúkrahúsi (0,5% á móti 0,3%; NS) voru álíka hjá konum og körlum, ef frá er talið að hlutfallslega fleiri konur fengu blæðingu á stungustað í nára (1,25% á móti 0,12%; p<0,001) og gervigúl á náraslagæð (2,1% á móti 0,6%; p<0,001). Ályktun: Frumárangur kransæðavíkkana hér á landi er góður og sambærilegur hjá konum og körlum. Dánarlíkur á sjúkrahúsi eru lágar og helstu fylgikvillar álíka algengir hjá kynjunum, nema hvað náravandamál á stungustað eru tíðari hjá konum.
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