Division of Cardiovascular Medicine, University of California, Davis Medical Center, Sacramento, CA, USA.
Am J Cardiol. 2010 Feb 1;105(3):339-42. doi: 10.1016/j.amjcard.2009.09.035. Epub 2009 Dec 21.
The comparative operative mortality (OM) in women and men undergoing isolated coronary artery bypass graft surgery (CABG) has not been clarified. Therefore, we evaluated factors related to OM in a large cohort of women and men undergoing isolated CABG. Results from 121 hospitals on patients undergoing isolated CABG in 2003 and 2004 were analyzed according to gender, including demographics, clinical characteristics, and surgical outcome. A total of 10,708 women and 29,669 men had isolated CABG in 2003 to 2004. Observed mortality in women was significantly higher than in men (4.60% vs 2.53%, p <0.0001). Although men had a higher prevalence of >3 diseased coronary arteries and left ventricular dysfunction, women were more likely to be older, diabetic, have stage 3 to 5 chronic kidney disease, chronic lung disease, and nonelective CABG. Women were less likely to receive an internal mammary artery graft. Multivariate analysis indicated that women were at higher risk for OM than men (odds ratio 1.61, 95% confidence interval 1.40 to 1.84). In conclusion, data from the large state-mandated CCORP indicate that women are at increased risk of OM after isolated CABG compared to men, despite adjustment for preoperative risk factors.
在接受单纯冠状动脉旁路移植术(CABG)的女性和男性中,比较手术死亡率(OM)尚未明确。因此,我们评估了在接受单纯 CABG 的大量女性和男性患者中与 OM 相关的因素。根据性别分析了 2003 年和 2004 年 121 家医院接受单纯 CABG 的患者的结果,包括人口统计学、临床特征和手术结果。2003 年至 2004 年期间,共有 10708 名女性和 29669 名男性接受了单纯 CABG。女性的观察死亡率明显高于男性(4.60%比 2.53%,p<0.0001)。尽管男性多有>3 支病变的冠状动脉和左心室功能障碍,但女性更可能年龄较大、患有糖尿病、处于 3 至 5 期慢性肾脏病、慢性肺部疾病且非择期 CABG。女性接受内乳动脉移植物的可能性较小。多变量分析表明,与男性相比,女性 OM 的风险更高(比值比 1.61,95%置信区间 1.40 至 1.84)。总之,来自大型州授权 CCORP 的数据表明,与男性相比,女性在接受单纯 CABG 后 OM 的风险增加,尽管对术前危险因素进行了调整。