Langtímahorfur sjúklinga með bráða kransæðastíflu

Abstract

Inngangur: Hratt lækkandi dánartíðni vegna kransæðasjúkdóma á Íslandi helst í hendur við samsvarandi lækkandi nýgengi kransæðastíflu á undanförnum þremur áratugum. Markmið þessarrar rannsóknar var að bera saman langtímalifun einstaklinga með NSTEMI (Non-ST elevation myocardial infarction) og STEMI (ST elevation myocardial infarction) og kanna áhrif áhættuþátta á lifun.

Efniviður og aðferðir: Rannsóknin náði til allra sjúklinga sem greindust með bráða kransæðastíflu á Landspítala árið 2006. Upplýsingar um áhættuþætti hjarta- og æðasjúkdóma og greiningar voru fengnar úr Sögukerfi spítalans. Sjúklingum var fylgt eftir fram til 1. janúar 2015. Endapunktur rannsóknarinnar var andlát af hvaða orsök sem er. Samsettur endapunktur var dauðsfall eða endurinnlögn vegna kransæðastíflu.

Niðurstöður: Á árinu 2006 greindust 447 einstaklingar með bráða kransæðastíflu á Landspítala, þar af voru 280 með NSTEMI (I21.4) og 167 með STEMI (I21 - I21.9). Nýgengi NSTEMI árið 2006 var 91,3 á hverja 100.000 íbúa. Nýgengi STEMI árið 2006 var 55,9 á hverja 100.000 íbúa. Meðalaldur NSTEMI-sjúklinga var 73,0 ár. Konur með NSTEMI voru að meðaltali 8,4 árum eldri en karlar með NSTEMI (konur 78,3 ár og karlar 69,9 ár). Meðalaldur STEMI-sjúklinga var 65,3 ár. Konur með STEMI voru að meðaltali 7,3 árum eldri en karlar með STEMI (konur 70,4 ár og karlar 63 ár). Fimm ára lifun NSTEMI-sjúklinga var 51%, 42% meðal kvenna og 57% meðal karla. Fimm ára lifun STEMI sjúklinga var 77%, 68% meðal kvenna og 80% meðal karla (logrank: p<0,01). Eftir aldursleiðréttingu var marktækt verri langtímalifun eftir NSTEMI samanborið við STEMI.

Ályktanir: Nýgengi NSTEMI var hærra en STEMI á Íslandi árið 2006. Konur höfðu verri langtímahorfur en karlar, sem skýrist af hærri meðal­aldri þeirra. Langtímalifun NSTEMI-sjúklinga var verri en lifun STEMI sjúklinga þrátt fyrir aldursleiðréttingu.

Senda grein,Prenta greinEnglishFacebookTwitter Introduction: Despite the decreasing incidence rate of acute coronary syndromes worldwide, the incidence of NSTEMI (Non- ST elevation myocardial infarction) has increased relative to STEMI (ST elevation myocardial infarction). The aim of this study was to compare long-term survival rates of NSTEMI and STEMI patients and to explore the effects of risk factors on survival.

Material and methods: All patients hospitaized for acute myocardial infarction at Landspitali University Hospital during the calendar year of 2006 were included in the study. Information about risk factors was obtained using electronic medical records. The primary endpoint was all cause mortality, the secondary endpoint was defined as death or myocardial infartion. Patients were followed up to January 1st 2015.

Results: Among 447 patients diagnosed with acute myocardial infarction in Iceland in 2006, 280 patients were diagnosed with NSTEMI (I21.4) and 167 with STEMI (I21, I21.9). NSTEMI and STEMI incidence rates per 100.000 inhabitants in Iceland were 91.3 and 55.9, respectively. The mean age of NSTEMI patients was 73.0 years, women were on average 8.4 years older than men. The mean age of STEMI patients was 65.3 years, women were on average 7.3 years older than men. The five-year survival rate for NSTEMI patients was 51%, 42% among women and 57% among men. The five-year survival rate for STEMI patients was 77%, 68% among women and 80% among men. Five year age-adjusted survival rates were higher for STEMI than NSTEMI (logrank: p <0.01).

Conclusion: The incidence of NSTEMI was higher than that of STEMI in Iceland in 2006. The worse prognosis of women as compared to men was due to the higher mean age of women. Overall, long-term survival of NSTEMI patients was worse than that of STEMI patients even after adjustment for difference in age.