Williams M R, Choudhri A F, Morales D L, Helman D N, Oz M C
Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
J Gend Specif Med. 2000 Jan-Feb;3(1):41-8.
To determine why women have a higher mortality rate than men when undergoing coronary artery bypass grafting.
Retrospective analysis of patients entered in a mandatory state database.
19,224 patients who underwent coronary artery bypass grafting in New York State in 1995.
The authors evaluated data pertaining to 27 variables. They conducted univariate analysis using the Student t test for continuous variables and the chi-square test or the Fisher exact test for discrete data. They conducted multivariate analysis using a logistic regression model.
Analysis of body surface area revealed that smaller size was a risk factor for both women and men. Analysis of age demonstrated increased risk for mortality in women in both older and younger subpopulations. Other significant variables included a lesser degree of revascularization and less frequent use of the internal mammary artery in women.
Smaller size and advanced age alone do not explain why female gender is an independent risk factor for mortality from coronary artery bypass grafting. Increased mortality is probably due to the fact that women have more comorbid conditions than men at the time of referral, perhaps because they are not being evaluated aggressively enough.
确定女性在接受冠状动脉旁路移植术时死亡率高于男性的原因。
对纳入强制性州数据库的患者进行回顾性分析。
1995年在纽约州接受冠状动脉旁路移植术的19224例患者。
作者评估了与27个变量相关的数据。对于连续变量，他们使用Student t检验进行单变量分析；对于离散数据，他们使用卡方检验或Fisher精确检验。他们使用逻辑回归模型进行多变量分析。
体表面积分析显示，体型较小对女性和男性都是一个危险因素。年龄分析表明，在老年和年轻亚组中，女性的死亡风险均增加。其他显著变量包括女性的血运重建程度较低以及较少使用乳内动脉。
体型较小和年龄较大本身并不能解释为什么女性是冠状动脉旁路移植术死亡的独立危险因素。死亡率增加可能是因为女性在转诊时比男性有更多的合并症，也许是因为对她们的评估不够积极。
