Kurlansky Paul A, Traad Ernest A, Galbut David L, Singer Samuel, Zucker Melinda, Ebra George
Miami Heart Research Institute, Mount Sinai Medical Center, Miami Beach, Florida 33140, USA.
Ann Thorac Surg. 2002 Nov;74(5):1517-25. doi: 10.1016/s0003-4975(02)03712-8.
Coronary bypass surgery carries a higher operative mortality and less favorable long-term clinical benefits for women than men. The impact of arterial revascularization on long-term results, including quality of life (QOL) in women, compared with men, has not been clearly defined.
A retrospective analysis was performed comparing 261 consecutive women patients from a single surgical practice receiving bilateral internal mammary artery (IMA) and supplemental vein grafts between January 1972 and October 1994 with a computer-matched cohort of 261 men undergoing bilateral IMA surgery during the same time period. Univariate analysis confirmed the homogeneity of the two groups based on multiple preoperative variables. The SF-36 QOL assessment tool was completed for all patients at follow-up, which ranged from 1 month to 25 years, with a mean follow-up of 9.1 years for women and 8.6 years for men.
There was no significant difference in operative mortality, nor in the incidence of any of 10 postoperative complications evaluated. The actuarial survival at 15 years was 53.7% +/- 4.8% for women and 50.9% +/- 5.6% for men (p = 0.218). At follow-up, 97.0% of women and 94.3% of men were free of angina and in Canadian Cardiovascular Society (CCS) class I or II. The need for reoperation (1.8% vs 1.9%) and PTCA (4.8% vs. 3.2%) was comparable in both groups. However, a higher rate of late myocardial infarction was found in women than men (1.8% vs 0.6, p = 0.021). The long-term event-free survival was found to be no different in men than women (p = 0.084). QOL as measured by the SF-36 was compared with the general population corrected for age and gender. Men and women scored as well or better than the general population in a majority of the eight health scales. Moreover, with regard to the health summary scores, men scored significantly higher (p = 0.001) in physical health, whereas women scored significantly higher (p = 0.011) in mental health when compared with age-adjusted norms.
Men and women undergoing coronary revascularization using bilateral internal mammary artery conduits experience comparable outcomes, excellent long-term results, and enjoy a QOL comparable to or better than the general population as measured by the SF-36.
与男性相比，冠状动脉搭桥手术对女性的手术死亡率更高，长期临床益处也更差。与男性相比，动脉血运重建对包括女性生活质量（QOL）在内的长期结果的影响尚未明确界定。
进行了一项回顾性分析，将1972年1月至1994年10月期间来自单一外科手术科室的261例连续接受双侧乳内动脉（IMA）和补充静脉移植的女性患者与同期接受双侧IMA手术的261例计算机匹配男性队列进行比较。单因素分析基于多个术前变量证实了两组的同质性。所有患者在随访时均完成了SF - 36生活质量评估工具，随访时间从1个月到25年不等，女性的平均随访时间为9.1年，男性为8.6年。
手术死亡率以及所评估的10种术后并发症的发生率均无显著差异。女性15年的精算生存率为53.7%±4.8%，男性为50.9%±5.6%（p = 0.218）。在随访时，97.0%的女性和94.3%的男性无心绞痛，且处于加拿大心血管学会（CCS）I级或II级。两组再次手术的需求（1.8%对1.9%）和经皮冠状动脉腔内血管成形术（PTCA）的需求（4.8%对3.2%）相当。然而，女性晚期心肌梗死的发生率高于男性（1.8%对0.6%，p = 0.021）。发现男性和女性的长期无事件生存率没有差异（p = 0.084）。通过SF - 36测量的生活质量与根据年龄和性别校正的一般人群进行了比较。在八个健康量表中的大多数方面，男性和女性的得分与一般人群相同或更好。此外，关于健康总结得分，与年龄调整后的标准相比，男性在身体健康方面得分显著更高（p = 0.001），而女性在心理健康方面得分显著更高（p = 0.011）。
使用双侧乳内动脉导管进行冠状动脉血运重建的男性和女性具有相似的结果、出色的长期效果，并且通过SF - 36测量的生活质量与一般人群相当或更好。
