Guru Veena, Fremes Stephen E, Tu Jack V
Institute for Clinical Evaluative Sciences, and Division of Cardiovascular Surgery, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.
J Thorac Cardiovasc Surg. 2004 Apr;127(4):1158-65. doi: 10.1016/j.jtcvs.2003.12.008.
This study explores the relative early and late mortality risks in women and men after coronary artery bypass graft surgery.
This was a retrospective cohort study (n = 54,425 patients, 12,079 women) using clinical data for all patients who underwent isolated coronary artery bypass graft surgery in Ontario between fiscal years 1991 and 1999 obtained from the Cardiac Care Network database, with outcomes of early (< or =1 year) and late (>1 year up to 10 years) interval mortality identified through linkage to administrative databases.
Female surgical candidates were older (65 vs 62 years, P <.0001) and higher-risk patients. The risk-adjusted survival of female patients was worse than that of male patients in the first year after coronary artery bypass graft surgery, but their long-term mortality was similar to that of male patients. The Cox proportional hazards model for early mortality had an adjusted female hazard ratio of 1.44 (95% confidence interval, 1.29-1.61; P =.02). This significantly differed from the late mortality model, which had a hazard ratio of 0.89 (95% confidence interval, 0.78-1.0; P =.06).
Early mortality was significantly higher for women after coronary artery bypass graft surgery, despite adjustment for confounding factors. However, the long-term relative mortality risk for women appeared equivalent to or even better than that experienced by men as early as 1 year after coronary artery bypass graft surgery. This population-based study of long-term mortality supports the benefits of coronary artery bypass graft surgery for women in the current era. However, further research is needed to identify ways to reduce early postoperative mortality in women.
本研究探讨冠状动脉搭桥手术后女性和男性相对的早期和晚期死亡风险。
这是一项回顾性队列研究（n = 54425例患者，其中12079例为女性），使用从心脏护理网络数据库获取的1991财年至1999年安大略省所有接受单纯冠状动脉搭桥手术患者的临床数据，并通过与行政数据库的链接确定早期（≤1年）和晚期（>1年至10年）区间死亡率的结果。
女性手术候选者年龄较大（65岁对62岁，P <.0001）且为高风险患者。冠状动脉搭桥手术后第一年，女性患者经风险调整后的生存率低于男性患者，但她们的长期死亡率与男性患者相似。早期死亡率的Cox比例风险模型中，女性调整后的风险比为1.44（95%置信区间，1.29 - 1.61；P =.02）。这与晚期死亡率模型有显著差异，晚期死亡率模型的风险比为0.89（95%置信区间，0.78 - 1.0；P =.06）。
尽管对混杂因素进行了调整，但冠状动脉搭桥手术后女性的早期死亡率仍显著较高。然而，女性的长期相对死亡风险在冠状动脉搭桥手术后最早1年时似乎等同于甚至优于男性。这项基于人群的长期死亡率研究支持了当代冠状动脉搭桥手术对女性的益处。然而，需要进一步研究以确定降低女性术后早期死亡率的方法。
