NgoNovemba 16, 2019-NguTracie White
uvavanyo
UDavid Maron
Izigulana ezinesifo sentliziyo esiqatha kodwa ezinzile ezinyangwa ngamayeza kunye neengcebiso ngendlela yokuphila yodwa azisekho semngciphekweni wokuhlaselwa sisifo sentliziyo okanye ukufa kunabo benza utyando oluhlaselayo, ngokutsho kwetyala elikhulu, elixhaswa ngemali ngumanyano lwezonyango olukhokelwa ngabaphandi eStanford. Isikolo soNyango kunye nesikolo sezonyango seYunivesithi yaseNew York.
Ulingo luye lwabonisa, nangona kunjalo, ukuba phakathi kwezigulana ezinesifo se-coronary artery nazo zineempawu ze-angina - iintlungu zesifuba ezibangelwa kukuhamba kwegazi okuthintelweyo ukuya entliziyweni - unyango oluneenkqubo ezihlaselayo, ezifana ne-stents okanye utyando lwe-bypass, lwalusebenza ngakumbi ekudambiseni iimpawu. kunye nokuphucula umgangatho wobomi.
"Kwizigulane ezinesifo senhliziyo esinzima kodwa esizinzile esingafuni ukwenza ezi nkqubo ezihlaselayo, ezi ziphumo ziqinisekisa kakhulu," kusho uDavid Maron, MD, unjingalwazi wezonyango kunye nomlawuli we-cardiology yokukhusela kwi-School of Medicine yaseStanford, kwaye i-co-chair yolingo, ebizwa ngokuba yi-ISCHEMIA, ye-International Study of Health Comparative Effectiveness kunye ne-Medical and Invasive Approaches.
"Iziphumo azicebisi ukuba kufuneka baqhube iinkqubo zokuthintela iziganeko zentliziyo," wongezelela uMaron, oyintloko yeZiko loPhando loPhando lwaseStanford.
Iziganeko zempilo ezilinganiswe ngophando zibandakanya ukufa kwisifo senhliziyo, ukuhlaselwa yintliziyo, ukulaliswa esibhedlele ngenxa ye-angina engazinzanga, ukulaliswa esibhedlele ngenxa yokungaphumeleli kwentliziyo kunye nokuvuselela emva kokubanjwa kwentliziyo.
Iziphumo zophononongo, ezibandakanya abathathi-nxaxheba be-5,179 kwiindawo ze-320 kumazwe angama-37, zanikezelwa nge-16 kaNovemba kwi-American Heart Association's Scientific Sessions 2019 eyayibanjelwe ePhiladelphia.UJudith Hochman, MD, umncedisi omkhulu onxulumene nesayensi yezonyango kwi-NYU Grossman School of Medicine, wayengusihlalo wolingo.Amanye amaziko abandakanyekayo kuhlalutyo lwesifundo yayiyi-Saint Luke's Mid America Heart Institute kunye neYunivesithi yaseDuke.I-National Heart, Lung, kunye neZiko leGazi lityale imali engaphezulu kwe-100 yezigidi zeedola kuphononongo, olwaqala ukubhalisa abathathi-nxaxheba kwi-2012.
'Omnye wemibuzo ephambili'
"Oku kuye kwaba ngomnye wemibuzo ephambili yeyeza le-cardiovascular ixesha elide: Ngaba unyango lwezonyango lodwa okanye unyango lwezonyango oludityaniswe neenkqubo ezihlaselayo zesiqhelo lolona nyango lungcono kweli qela lezigulana zentliziyo ezizinzileyo?"uthe umphandi-mphandi wokufunda uRobert Harrington, MD, unjingalwazi kunye nosihlalo weyeza eStanford kunye no-Arthur L. Bloomfield uNjingalwazi weMedicine."Ndibona oku njengokunciphisa inani leenkqubo ezihlaselayo."
uvavanyo
URobert Harrington
Uphononongo lwenzelwe ukubonakalisa uqheliselo lweklinikhi lwangoku, apho izigulane ezinezithintelo ezinzima kwimithambo yazo zihlala zifumana i-angiogram kunye ne-revascularization nge-stent implant okanye utyando lwe-bypass.Ukuza kuthi ga ngoku, kukho ubungqina obuncinci besayensi bokuxhasa ukuba ngaba ezi nkqubo zisebenza ngakumbi ekuthinteleni iziganeko ezimbi zentliziyo kunokunyanga nje izigulana ngamayeza afana ne-aspirin kunye ne-statins.
"Ukuba ucinga ngako, kukho intuitiveness yokuba ukuba kukho ukuvaleka kwi-artery kunye nobungqina bokuba oko kuvaleka kubangela ingxaki, ukuvula loo nto ibangela ukuba abantu bazive ngcono kwaye baphile ixesha elide," utshilo uHarrington, ohlala ebona izigulana. kunye nesifo se-cardiovascular in Stanford Health Care.“Kodwa khange kubekho bungqina bokuba le yinyani.Yiyo loo nto siye senza esi sifundo.”
Unyango oluhlaselayo lubandakanya i-catheterization, inkqubo apho i-catheter efana netyhubhu ityibilika kwi-artery kwi-groin okanye engalweni kwaye ifakwe kwimithambo yegazi ukuya entliziyweni.Oku kulandelwa yi-revascularization, njengoko kuyimfuneko: ukufakwa kwe-stent, efakwe kwi-catheter ukuvula isitya segazi, okanye utyando lwe-cardiac bypass, apho enye i-artery okanye i-vein iphinda isetyenziswe ukudlula indawo yokuvalwa.
Abaphandi bafunda izigulane zentliziyo ezizinzile kodwa zihlala ngokumodareyitha ukuya kwi-ischemia enzima ebangelwa ngokuyinhloko yi-atherosclerosis - iidiphozithi ze-plaque kwi-arteries.I-Ischemic heart disease, eyaziwa ngokuba yi-coronary artery disease okanye isifo senhliziyo, lolona hlobo luqhelekileyo lwesifo senhliziyo.Izigulane ezinesifo ziye zanciphisa imithwalo yentliziyo ethi, xa ivalwe ngokupheleleyo, ibangele ukuhlaselwa yintliziyo.Malunga ne-17.6 yezigidi zabantu baseMelika bahlala nale meko, ekhokelela ekufeni kwabantu abangama-450,000 ngonyaka, ngokutsho kweAmerican Heart Association.
I-Ischemia, eyancipha ukuhamba kwegazi, idla ngokubangela iimpawu zentlungu yesifuba eyaziwa ngokuba yi-angina.Malunga nesibini kwisithathu sezo zigulana zentliziyo ezibhaliswe kuphononongo zafumana iimpawu zentlungu yesifuba.
Iziphumo zolu pho nonongo azisebenzi kubantu abaneemeko ezinzima zentliziyo, njengabo banesifo sentliziyo, bathi abaphandi.Abantu abajongene neziganeko ezibuhlungu zentliziyo kufuneka bafune ngokukhawuleza unyango olufanelekileyo.
Ukufunda ngokungakhethiyo
Ukuqhuba isifundo, abaphandi bahlula ngokungenamkhethe izigulane zibe ngamaqela amabini.Omabini amaqela afumene amayeza kunye neengcebiso zendlela yokuphila, kodwa linye kuphela iqela eliye lafumana iinkqubo ezihlaselayo.Uphononongo lulandele izigulane phakathi kwe-1½ kunye neminyaka esixhenxe, ukugcina iithebhu kuzo naziphi na iziganeko zentliziyo.
Iziphumo zabonisa ukuba abo baye benza inkqubo ehlaselayo babenezinga eliphezulu le-2% lezehlo zentliziyo kunyaka wokuqala xa kuthelekiswa nezo zikunyango lwezonyango kuphela.Oku kubangelwa yimingcipheko eyongezelelweyo ezayo kunye neenkqubo ezihlaselayo, abaphandi bathi.Kunyaka wesibini, akukho mahluko ubonakalisiweyo.Ngomnyaka wesine, izinga leziganeko laliphantsi kwe-2% kwizigulane eziphathwe ngeenkqubo zentliziyo kunezo zamayeza kunye neengcebiso zokuphila zodwa.Lo mkhwa ubangele ukuba akukho mahluko mkhulu phakathi kweendlela ezimbini zonyango, abaphandi bathi.
Phakathi kwezigulane ezichaze iintlungu zesifuba zemihla ngemihla okanye ngeveki ekuqaleni kophononongo, i-50% yalabo baphathwa ngokungena-invasive bafunyenwe be-angina-free emva konyaka, xa kuthelekiswa ne-20% yabo baphathwa ngendlela yokuphila kunye neyeza kuphela.
"Ngokusekelwe kwiziphumo zethu, sincoma ukuba zonke izigulane zithathe amayeza abonakaliswe ukunciphisa umngcipheko wokuhlaselwa yintliziyo, ukusebenza ngokomzimba, ukutya ukutya okunempilo kunye nokuyeka ukutshaya," kusho uMaron."Izigulane ezingenayo i-angina aziyi kubona phuculo, kodwa abo bane-angina yabo nabuphi na ubunzima baya kuthanda ukuba nophuculo olukhulu, oluhlala luhleli kumgangatho wobomi ukuba banenkqubo yentliziyo ehlaselayo.Bafanele bathethe noogqirha babo ukuze benze isigqibo sokuba baphinde bangene kwi-revascularization.
Abaphandi baceba ukuqhubeka nokulandela abathathi-nxaxheba bokufunda eminye iminyaka emihlanu ukugqiba ukuba ngaba iziphumo ziguquka kwixesha elide.
“Kuya kubaluleka ukulandelela ukujonga ukuba, ekuhambeni kwexesha, kuya kubakho umahluko.Ngeli xesha silandela abathathi-nxaxheba, akukho nzuzo kwaphela yokusinda kwiqhinga elihlaselayo, utshilo uMaron."Ndicinga ukuba ezi ziphumo kufuneka zitshintshe uqheliselo lweklinikhi.Uninzi lweenkqubo zenziwa kubantu abangenazo iimpawu.Kunzima ukuthethelela ukubeka izigulana kwizigulana ezizinzileyo nezingenazimpawu.”
Ixesha lokuposa: Nov-10-2023