Læknablaðið - 01.01.2015, Blaðsíða 34

34 LÆKNAblaðið 2015/101
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Heimildalistinn er birtur í heild sinni á heimasíðu blaðsins
Y f i R l i T
30 daga.121,122 Mest er þó áhættan hjá sjúklingum með alvarlegan
kransæðasjúkdóm og þeim sem koma til aðgerðar í losti vegna
bráðs hjartadreps.121,125
Lifun og forspárþættir
Rannsóknir á árangri kransæðahjáveituaðgerða hafa flestar beinst
að 30 daga dánartíðni (skurðdauða) fremur en langtímalifun. Þó
eru nokkrar rannsóknir sem sérstaklega hafa beinst að afdrifum
þessara sjúklinga til lengri tíma.126 Í bandarískri rannsókn reyndist
heildarlifun 5 árum eftir kransæðahjáveitu 86%,127 sem er heldur
lakari árangur en í íslenskri rannsókn þar sem 5 ára heildarlifun
var 90% (mynd 7).128 Sterkustu forspárþættir dauða innan 30 daga
frá aðgerð eru skert útfallsbrot, langur aðgerðartími, bráðaaðgerð,
langur legutími á gjörgæslu, óstöðug hjartaöng, sykursýki og
háþrýstingur.129 Í íslenskri rannsókn sem tók til sjúklinga eldri
en 75 ára voru mikilvægustu forspárþættir dauða innan 30 daga
insúlínháð sykursýki og alvarleg nýrnabilun.130 Í sömu rannsókn
reyndist lifun einu ári frá aðgerð vera 92%.
lokaorð
Árangur meðferðar við kransæðasjúkdómi hefur stórbatnað á
síðustu áratugum. Þessa þróun má rekja til ýmissa framfara, ekki
síst notkun statína, öflugri blóðflöguhemjandi lyfja og framfara
í kransæðavíkkunum, sérstaklega notkun nýrri stoðneta. Auk
þess hefur árangur hjáveituaðgerða batnað og eftirmeðferð er
markvissari. Nýjungar í meðferð hafa einnig fækkað fylgikvillum
og aukið lífsgæði sjúklinga, ekki síst í hópi aldraðra. Forvarnir og
bætt lýðheilsa eiga þó stærstan þátt í lækkandi dánartíðni krans-
æðasjúkdóms. Samvinna ýmissa sérgreina er lykilatriði að bættum
árangri, ekki síst náið samstarf hjartalækna, hjartaskurðlækna og
svæfinga- og gjörgæslulækna. Ekki má heldur gleyma hlutverki
heilsugæslulækna og fjölmargra annarra heilbrigðisstétta í for-
varnastarfi og eftirmeðferð, en öflugar forvarnir eru lykilatriði í að
koma frekari böndum á þetta umfangsmikla heilsufarsvandamál.