Nardi P, Pellegrino A, De Paulis R, Scafuri A, Versaci F, Polisca P, el-Fakhri F, Chiariello L
Cattedra di Cardiochirurgia, Università degli Studi Tor Vergata, Roma.
Ital Heart J Suppl. 2000 Apr;1(4):537-42.
Coronary artery bypass grafting is reported to have a higher (2-3 times) mortality in women than in men, most likely due to older age, higher incidence of hypertension, diabetes mellitus, hypercholesterolemia, obesity, angina and preoperative myocardial infarction, smaller diameter of coronary arteries, and smaller body surface area.
From January 1992 to December 1997, 347 female and 2098 male patients were submitted to isolated coronary artery bypass grafting. For both groups were considered: a) clinical presentation (age, height, weight, body surface area, NYHA and CCS functional classes, incidence of preoperative myocardial infarction); b) risk factors for cardiovascular diseases (diabetes mellitus, smoking habit, dyslipidemia, hypertension, familiarity); c) concomitant diseases (obesity, chronic obstructive pulmonary disease, peripheral vascular disease, thyroid dysfunction); d) hemodynamic and anatomical data (extent of coronary artery disease, diameter of coronary arteries, left ventricular function); e) surgical procedure (number and type of grafts used, urgent procedures, incidence of redo procedures). Early (up to 30 days after surgery) results were evaluated in terms of complications and mortality.
On admission, women were older than men (p = 0.0001), were shorter (p < 0.0001), weighed less (p < 0.0001), and had a smaller body surface area (p < 0.0001); they had more severe angina (p = 0.002), diabetes mellitus (p = 0.002), hypercholesterolemia (p = 0.003), thyroid dysfunction (p < 0.0001), their coronary arteries were smaller (left anterior descending artery, p = 0.05; obtuse marginal branch, p = 0.008; diagonal branch, p = 0.01), and had less grafts implanted at surgery (p = 0.02). There was no difference between women and men in the use of the internal thoracic artery. Women did not have a higher mortality than men (4.6 vs 3.2%). Uni- and multivariate analysis did not show extraoperative risk factors for women; for men older age (p = 0.005) and poor left ventricular function (p = 0.01) were independent predictive factors of operative mortality.
In spite of what is suggested by the literature, coronary artery bypass grafting does not have a significant higher operative risk for women than men, probably due to surgical technique refinements and extensive use of the internal thoracic artery.
据报道，冠状动脉搭桥术的女性死亡率比男性高（2至3倍），这很可能是由于女性年龄较大、高血压、糖尿病、高胆固醇血症、肥胖、心绞痛和术前心肌梗死的发病率较高、冠状动脉直径较小以及体表面积较小。
从1992年1月至1997年12月，347例女性和2098例男性患者接受了单纯冠状动脉搭桥术。对两组患者均考虑以下因素：a）临床表现（年龄、身高、体重、体表面积、纽约心脏协会和加拿大心血管学会功能分级、术前心肌梗死发生率）；b）心血管疾病危险因素（糖尿病、吸烟习惯、血脂异常、高血压、家族史）；c）伴随疾病（肥胖、慢性阻塞性肺疾病、外周血管疾病、甲状腺功能障碍）；d）血流动力学和解剖学数据（冠状动脉疾病范围、冠状动脉直径、左心室功能）；e）手术过程（所用移植物的数量和类型、急诊手术、再次手术发生率）。根据并发症和死亡率评估早期（术后30天内）结果。
入院时，女性年龄比男性大（p = 0.0001），身高较矮（p < 0.0001），体重较轻（p < 0.0001），体表面积较小（p < 0.0001）；她们有更严重的心绞痛（p = 0.002）、糖尿病（p = 0.002）、高胆固醇血症（p = 0.003）、甲状腺功能障碍（p < 0.0001），其冠状动脉较小（左前降支，p = 0.05；钝缘支，p = 0.008；对角支，p = 0.01），且手术时植入的移植物较少（p = 0.02）。女性和男性在使用胸廓内动脉方面没有差异。女性死亡率并不高于男性（4.6%对3.2%）。单因素和多因素分析均未显示女性存在手术外危险因素；对于男性，年龄较大（p = 0.005）和左心室功能较差（p = 0.01）是手术死亡率的独立预测因素。
尽管文献有相关提示，但冠状动脉搭桥术对女性而言，手术风险并不显著高于男性，这可能归因于手术技术的改进以及胸廓内动脉的广泛使用。
