Toumpoulis Ioannis K, Anagnostopoulos Constantine E, Balaram Sandhya K, Rokkas Chris K, Swistel Daniel G, Ashton Robert C, DeRose Joseph J
College of Physicians and Surgeons Columbia University, Department of Cardiothoracic Surgery, St Luke's-Roosevelt Hospital Center, New York, NY 10128, USA.
J Thorac Cardiovasc Surg. 2006 Feb;131(2):343-51. doi: 10.1016/j.jtcvs.2005.08.056. Epub 2006 Jan 18.
The long-term mortality of coronary artery bypass grafting in women in not certain. The purpose of this study was to determine and compare risk factors for long-term mortality in women and men undergoing coronary artery bypass grafting.
Between 1992 and 2002, 3760 consecutive patients (2598 men and 1162 women) underwent isolated coronary artery bypass grafting. Long-term survival data were obtained from the National Death Index (mean follow-up, 5.1 +/- 3.2 years). Multivariable Cox regression analysis was performed, including 64 preoperative, intraoperative, and postoperative factors separately in women and men.
There were no differences in in-hospital mortality (2.7% in men vs 2.9% in women, P = .639) and 5-year survival (82.0% +/- 0.8% in men vs 81.1% +/- 1.3% in women, P = .293). After adjustment for all independent predictors of long-term mortality, female sex was an independent predictor of improved 5-year survival (hazard ratio, 0.82; 95% confidence interval, 0.71-0.96; P = .014). Twenty-one independent predictors for long-term mortality were determined in men, whereas only 12 were determined in women. There were 9 common risk factors (age, ejection fraction, diabetes mellitus, > or =2 arterial grafts, postoperative myocardial infarction, deep sternal wound infection, sepsis and/or endocarditis, gastrointestinal complications, and respiratory failure); however, their weights were different between women and men. Malignant ventricular arrhythmias, calcified aorta, and preoperative renal failure were independent predictors only in women. Emergency operation, previous cardiac operation, peripheral vascular disease, left ventricular hypertrophy, current and past congestive heart failure, chronic obstructive pulmonary disease, body mass index of greater than 29, preoperative dialysis, thrombolysis within 7 days before coronary artery bypass grafting, intraoperative stroke, and postoperative renal failure were independent predictors only in men.
Despite equality between sexes in early outcome and superiority of female sex in long-term survival, there were 3 independent predictors for long-term mortality after coronary artery bypass grafting unique for women compared with 12 for men. Clinical decision making and follow-up should not be influenced by stereotypes but by specific findings.
冠状动脉搭桥术（CABG）女性患者的长期死亡率尚不确定。本研究旨在确定并比较接受CABG的女性和男性患者长期死亡的危险因素。
1992年至2002年期间，3760例连续患者（2598例男性和1162例女性）接受了单纯CABG。长期生存数据来自国家死亡指数（平均随访时间为5.1±3.2年）。进行多变量Cox回归分析，分别纳入女性和男性患者术前、术中和术后的64个因素。
住院死亡率（男性为2.7%，女性为2.9%，P = 0.639）和5年生存率（男性为82.0%±0.8%，女性为81.1%±1.3%，P = 0.293）无差异。在对所有长期死亡的独立预测因素进行校正后，女性是5年生存率提高的独立预测因素（风险比，0.82；95%置信区间，0.71 - 0.96；P = 0.014）。确定了男性患者长期死亡的21个独立预测因素，而女性患者仅12个。有9个共同的危险因素（年龄、射血分数、糖尿病、≥2支动脉移植物、术后心肌梗死、胸骨深部伤口感染、败血症和/或心内膜炎、胃肠道并发症和呼吸衰竭）；然而，它们在女性和男性中的权重不同。恶性室性心律失常、主动脉钙化和术前肾衰竭仅为女性患者的独立预测因素。急诊手术、既往心脏手术、外周血管疾病、左心室肥厚、目前和既往充血性心力衰竭、慢性阻塞性肺疾病、体重指数大于29、术前透析、冠状动脉搭桥术前7天内溶栓、术中卒中及术后肾衰竭仅为男性患者的独立预测因素。
尽管在早期结局方面两性平等，且女性在长期生存方面具有优势，但与男性的12个因素相比，冠状动脉搭桥术后女性有3个独特的长期死亡独立预测因素。临床决策和随访不应受刻板印象影响，而应依据具体发现。
