Vaccarino Viola, Abramson Jerome L, Veledar Emir, Weintraub William S
Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA 30306, USA.
Circulation. 2002 Mar 12;105(10):1176-81. doi: 10.1161/hc1002.105133.
Data are conflicting over whether women have higher mortality than men after coronary artery bypass graft (CABG) surgery. Younger but not older women hospitalized for acute myocardial infarction have higher in-hospital mortality rates than men. We hypothesized that younger women also have higher in-hospital mortality rates after CABG.
We studied 51 187 patients (30% women) included in the National Cardiovascular Network database who received CABG at 23 clinical centers between October 1993 and December 1999. Compared with men, fewer women were white and more women had risk factors and comorbidities. These differences were more apparent in younger patients. In all age groups, however, women had higher left ventricular ejection fraction and fewer diseased vessels. Women had higher in-hospital mortality rates than men, but sex differences in mortality were more marked among younger patients. Women <50 years of age were 3 times more likely to die than men (3.4% versus 1.1%), and women 50 to 59 years of age were 2.4 times more likely to die than men (2.6% versus 1.1%). In the older age categories, the sex difference in in-hospital mortality was less marked (P<0.001 for the interaction between sex and age). Adjustment for preoperative risk factors only slightly decreased the strength of this interaction.
Younger women undergoing CABG surgery are at a higher risk of in-hospital death than men, but this difference in risk decreases with advancing age. Additional investigation is needed to determine why in-hospital mortality is higher in women after CABG, with particular focus on younger women.
关于冠状动脉旁路移植术（CABG）后女性死亡率是否高于男性的数据存在矛盾。因急性心肌梗死住院的年轻女性而非老年女性的院内死亡率高于男性。我们推测年轻女性在CABG术后也有较高的院内死亡率。
我们研究了纳入国家心血管网络数据库的51187例患者（30%为女性），这些患者于1993年10月至1999年12月期间在23个临床中心接受了CABG。与男性相比，女性中白人较少，且有更多女性存在危险因素和合并症。这些差异在年轻患者中更为明显。然而，在所有年龄组中，女性的左心室射血分数较高，病变血管较少。女性的院内死亡率高于男性，但死亡率的性别差异在年轻患者中更为显著。年龄<50岁的女性死亡可能性是男性的3倍（3.4%对1.1%），50至59岁的女性死亡可能性是男性的2.4倍（2.6%对1.1%）。在老年组中，院内死亡率的性别差异不太明显（性别与年龄之间的交互作用P<0.001）。仅对术前危险因素进行调整只会略微降低这种交互作用的强度。
接受CABG手术的年轻女性院内死亡风险高于男性，但这种风险差异会随着年龄增长而减小。需要进一步研究以确定CABG术后女性院内死亡率较高的原因，尤其要关注年轻女性。
