Guru Veena, Fremes Stephen E, Austin Peter C, Blackstone Eugene H, Tu Jack V
Institute for Clinical Evaluative Sciences, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Canada.
Circulation. 2006 Jan 31;113(4):507-16. doi: 10.1161/CIRCULATIONAHA.105.576652.
There are few comparative data regarding long-term nonfatal outcomes for women versus men after coronary artery bypass grafting (CABG). This study compares gender differences in cardiac events in a population of hospital survivors up to 11 years after isolated CABG surgery in Ontario, Canada.
A population-based cohort study (n=68,774 patients, 15,043 women) between September 1, 1991, and April 1, 2002, was assembled with linked clinical and administrative databases. Cox modeling and propensity score matching were used to compare death, cardiac readmission (angina, heart failure, myocardial infarction), repeat revascularization (angioplasty or CABG), and stroke readmission between men and women. Women were older (65+/-17 versus 62+/-13 years), more likely to present with urgent or emergent status (64% versus 56%), and less likely to receive arterial grafts (70% versus 78%). Women had a higher rate of cardiac readmission in the first year after surgery (hazard ratio [HR] of 1.5, 95% confidence interval [CI] 1.36 to 1.56), and this increased risk persisted after 1 year (HR 1.2, 95% CI 1.14 to 1.31). This was primarily due to readmissions for unstable angina (HR 1.3, 95% CI 1.24 to 1.38) and congestive heart failure (HR 1.1, 95% CI 1.06 to 1.21). Propensity-matched women had similar rates of death (HR 0.9, 95% CI 0.83 to 0.98) and repeat revascularization (HR 1.0, 95% CI 0.91 to 1.06).
Women have a more complex clinical preoperative presentation and are more likely to be readmitted with unstable angina and congestive heart failure after CABG but experience survival similar to those seen in men. Gender differences in outcomes may be improved through durable revascularization strategies and close postoperative follow-up care targeted to women.
关于冠状动脉旁路移植术（CABG）后女性与男性的长期非致命性结局，可比较的数据较少。本研究比较了加拿大安大略省接受单纯CABG手术的医院幸存者人群中心脏事件的性别差异，随访时间长达11年。
利用临床和管理数据库建立了一项基于人群的队列研究（n = 68774例患者，其中15043例为女性），研究时间为1991年9月1日至2002年4月1日。采用Cox模型和倾向评分匹配法比较男性和女性之间的死亡、心脏再入院（心绞痛、心力衰竭、心肌梗死）、再次血运重建（血管成形术或CABG）以及卒中再入院情况。女性年龄更大（65±17岁 vs 62±13岁），更可能以紧急或急诊状态就诊（64% vs 56%），且接受动脉移植的可能性更小（70% vs 78%）。女性术后第一年心脏再入院率更高（风险比[HR]为1.5，95%置信区间[CI]为1.36至1.56），且这种增加的风险在1年后仍然存在（HR 1.2，95%CI 1.14至1.31）。这主要是由于不稳定型心绞痛（HR 1.3，95%CI 1.24至1.38）和充血性心力衰竭（HR 1.1，95%CI 1.06至1.21）的再入院。倾向评分匹配后的女性死亡率（HR 0.9，95%CI 0.83至0.98）和再次血运重建率（HR 1.0，95%CI 0.91至1.06）相似。
女性术前临床表现更为复杂，CABG术后因不稳定型心绞痛和充血性心力衰竭再次入院的可能性更大，但生存率与男性相似。通过持久的血运重建策略以及针对女性的密切术后随访护理，可能会改善结局方面的性别差异。
