| Sažetak | Istraživanje je provedeno u cilju utvrđivanja kliničko-epidemioloških značajki AKS-a u žena iz Splitsko-dalmatinske županije, hospitaliziranih od AKS-a u KBC-u Split u dvogodišnjem razdoblju 2007.-2008. godine. Žene su činile približno trećinu hospitaliziranih od AKS-a tijekom promatranog razdoblja. Među ženama s AKS-om u približno 4/5 utvrđen je AIM, a kod svake pete NAP, pri čemu je NSTEMI utvrđen u 28, 7% slučajeva, STEMI u 25, 2% te NAP u 21, 6%, dok je AIM ostao neklasificiran kod četvrtine ispitanica. Prema udjelu žene su prevladavale samo u najstarijoj dobnoj skupini, a broj oboljelih žena je rastao proporcionalno starenju. Umrle su bile starije od onih koje su preživjele (za STEMI starije 2, 39 godina, za NSTEMI 11, 72 godina, a za neklasificirani AIM 5, 70 godina). Žene su bile značajno starije od muškaraca (za 6, 3 godina kod umrlih, a za 7, 62 godina kod preživjelih). Među svim hospitaliziranima od AKS-a umrlo je više žena (11, 8%) nego muškaraca (6, 0%). U istraživanju je dokazano da su muški ispitanici s AKS-om značajno više preživljavali, te da ženski spol povećava rizik umiranja za 2, 1 put, a svaka godina života više u žena povećava rizik umiranja od AKS za 1, 07 puta. Ove bolesnice su kasnile s hospitalizacijom. Naime, 12, 0% žena je stiglo u bolnicu u roku 2 sata od početka boli, 21, 7% u vremenu 2-6 sati, 16, 0% u vremenu 6-12 sati, 18, 6% u vremenu 12-24 sata, te 31, 7% u vremenu duljem od 24 sata. Približno 1/3 svih zabilježenih komplikacija utvrđena je u žena, a muškaraca bez komplikacija je bilo značajno više. Komplikacija zatajivanje srca je bila vezana uz ženski spol. U preživjelih žena su također značajno češće kao čimbenici rizika nađeni hipertenzija, šećerna bolest i nestabilna angina pektoris, a kod muškaraca aktivno ili bivše pušenje. Umrle žene značajno su imale hipertenziju i šećernu bolest tip 2, a umrli muškarci aktivno pušenje. U ovom radu se pokazalo da su neinvazivni dijagnostički postupci ehokardiografije i ergometrije značajno češće obavljani u muškaraca nego u žena. Nije utvrđena rodna razlika u provođenju trombolize. Invazivni kardiološki postupci su značajno češće vršeni u muškaraca (koronarografija i PCI). Ispitanice s AKS-om su značajno više koristile ACE inhibitore, dok su ispitanici češće koristili statine prije hospitalizacije. Dokazano je da su prilikom bolničkog otpusta muškarcima značajno češće propisivali statini, a ženama ACE inhibitori. Ovo je istraživanje utvrdilo postojanje spolnih razlika u kliničko-epidemiološkim značajkama AKS-a kod stanovnika naše županije, te je uglavnom potvrdilo dosadašnje 55 rezultate provedenih istraživanja u svijetu. Međutim, donijelo je i nove spoznaje specifične za našu sredinu, koje je nužno dalje istraživati. Pozornost treba posvetiti edukaciji svih segmenata zajednice, te boljoj organizaciji zdravstvene zaštite. |
| Sažetak (engleski) | The study was carried out in order to determine the clinical and epidemiological
aspects of the ACS in women in the Split-Dalmatia County, hospitalised therewith in
the Clinical Hospital Centre Split during the period of two years, 2007 and 2008.
Women formed about one third of all persons hospitalised with the ACS during the
period in question. Among the women with ACS, four fifths of them were diagnosed
with the AIM and every fifth with the UAP, where the NSTEMI was diagnosed in
28.7% of cases, STEMI in 25.2% and UAP in 21.6%, whereas the AIM remained
unclassified in one fourth of cases. Women prevailed only in the oldest group of
patients and the number of women grew proportionally with age. It was shown that
women with the ACS who died were older than those who survived (for STEMI older
by 2.39 years, for NSTEMI by 11.72 years and for the unclassified AIM by 5.70 years).
Women were significantly older than men (by 6.3 years for those who died and by 7.62
for those who survived). Among all the hospitalised with ACS, more women (11.8%)
died than men (6.0%). More men survived than women, and the female sex increased
the risk of dying by 2.1 times, whereas with each year of life the risk of dying of the
ACS for women increased by 1.07 times. The women hospitalised with the ACS had a
delayed arrival to the hospital. Namely, 12.0% of women arrived within 2 hours since
the pain had started; 21.7% after 2-6 hours; 16.0% after 6-12 hours; 18.6% after 12-24
hours; and 31.7% after more than 24 hours. Approximately 1/3 of all the recorded
complications were diagnosed in the hospitalised women, and there were also more men
with the ACS without complications in comparison to women. Among the hospitalised
women with complications, there were significantly more of those with heart failure.
Hypertension, diabetes mellitus type 1, diabetes mellitus type 2 and unstable angina
pectoris were found as risk factors more frequently in women, and active or past
smoking in men. In women who were hospitalised and then died of the ACS,
hypertension and diabetes mellitus type 2 were found more frequently, and in men
active smoking. This study has shown that the non-invasive diagnostic procedures of
echocardiography and ergometry were performed more frequently on men than on
women. A significant difference in the performance of thrombolysis on men and on
women was not determined. The study has determined that the invasive cardiologic
procedures (such as coronarography and PCI) were significantly more frequently
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performed on men than on women. Women with the ACS used the ACE inhibitors
significantly more frequently, whereas men more often used the statins in the ACS
treatment before hospitalisation. Men received statins at the discharge from the hospital
significantly more frequently whereas women were given more ACE inhibitors.
This study has established the existence of differences between women and men
when it comes to the ACS clinical and epidemiological aspects among citizens of the
Split-Dalmatia County, and has mostly confirmed the past results of studies carried out
throughout the world. However, the study has also brought new perceptions specific for
our region which should be further examined. Attention should be paid to educating all
segments of the community and better organisation of the health care. |
