Læknablaðið - 15.10.2003, Page 27

FRÆÐIGREINAR / HRÖRNUNARSJÚKDÓMAR ( HEILA
að jafnaði minni en karla voru þær ekki líklegri til
að hafa grennri æðar sem þurftu græðling (28). í
bandarískri rannsókn var sjúkrahúsdauði eftir hjá-
veituaðgerð hærri hjá konum en körlum í öllum
aldurshópum, en hlutfallslega mest hjá konum
yngri en 60 ára og 70-79 ára (29). í CASS og BARI
rannsóknunum var lifun fimm til sex árum eftir
hjáveituaðgerð sambærileg milli kynja (30, 31).
Eftir fjölþáttagreiningu í BARI rannsókninni var
hins vegar langtímalifun kvenna betri en karlar
(31). Voru hlutfallslega fleiri þeirra með sykur-
sýki, en þekkt er að langtímaárangur hjáveituað-
gerðar er góður hjá sykursjúkum (32).
Bráðum kransæðavíkkunum hjá sjúklingum
með ST-hækkunar hjartadrep fer nú fjölgandi. Ein
rannsókn sýndi að eftir bráða víkkun voru líkur á
nýju hjartadrepi og dauða innan sex mánaða hærri
hjá konum en körlum, en sá munur hvarf þegar
leiðrétt var fyrir áhættuþætti (8). Lifun einu ári
eftir bráða víkkun vegna kransæðastíflu er líka
sambærileg hjá kynjunum þegar leiðrétt er fyrir á-
hættuþætti (17). Bráð víkkun er nú kjörmeðferð
hjá konum með marga áhættuþætti og minnkar
dánarlíkur þeirra, þó segaleysandi meðferð sé
einnig gagnleg (33). Notkun glýkóprótín Ilb/IIIa
hamla í víkkunaraðgerð lækkar dánarlíkur og þörf
á endurvíkkun innan 30 daga hjá báðum kynjum
(34), en árangur bráðrar víkkunar er þó meira
bættur með notkun stoðnets fremur en með gjöf
glýkóprótín Ilb/IIIa lyfja (35).
Núverandi rannsókn sýnir að hér á landi er
frumárangur kransæðavíkkana og helstu fylgikvill-
ar sambærileg hjá konum og körlum. Kyn á ekki að
hafa áhrif á hvort mælt er með kransæðavíkkun
eða hjáveituaðgerð hjá sjúklingi með kransæða-
sjúkdóm (36).
Þakkir
Sigurlaug Magnúsdóttir hjúkrunarfræðingur að-
stoðaði við söfnun gagna og innslátt í tölvuforrit
og Elísabet Snorradóttir læknaritari við gerð
handrits.
Heimildir
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