Rahimtoola S H, Bennett A J, Grunkemeier G L, Block P, Starr A
Griffith Center, University of Southern California, Los Angeles 90033.
Circulation. 1993 Nov;88(5 Pt 2):II71-8.
Coronary bypass surgery in women is associated with lower survival than in men. We need to know whether this is because of patient-related factors and whether the lower survival is present in all subgroups of patients and for all time periods during which the surgery was performed.
Using actuarial techniques, we determined the outcome of coronary bypass surgery performed for chronic stable and unstable angina in 1979 women and 6927 men. The operative mortality was 2.7% for women and 1.9% for men (P = .02). The higher operative mortality in women was seen in those with three-vessel disease or greater and abnormal left ventricular function (5.4% versus 2.8%, P = .009) and those with stable angina (2.6% versus 1.5%, P = .006). The 5-, 10-, 15-, and 18-year survival for women was 86 +/- 0.9%, 70 +/- 1.5%, 50 +/- 2.5%, and 37 +/- 6.4%, respectively, and for men, 88 +/- 0.4%, 73 +/- 0.7%, 54 +/- 1.2%, and 42 +/- 1.9%, respectively (P = .03). The lower survival in women compared with men was seen in those with three-vessel disease or greater and abnormal left ventricular function (at 10 years, 69 +/- 1.8% versus 73 +/- 0.8%, P = .005). At 15 years, the incidence of reoperation was 26 +/- 2.4% versus 28 +/- 1.2% and of myocardial infarction, 30 +/- 2.8% versus 32 +/- 1.3%, P = NS for either. The incidence of no angina or mild angina was 70% in women and 78% in men, P < .0001. The operative mortality and late survival of those operated on in different time periods for either women or men was not significantly different. Women were older (64 +/- 9.4 versus 61 +/- 9.9 years, P < .0001) and smaller (body surface area, 2.0 +/- 0.2 versus 1.7 +/- 0.2 m2, P < .0001), had a higher incidence of diabetes, systemic hypertension, and unstable angina, and had a smaller lumen of the left anterior descending coronary artery (1.7 +/- 0.4 versus 1.9 +/- 0.4 mm, P < .0001), right coronary artery, and diagonal arteries. More men were smokers, and men had a higher incidence of prior myocardial infarction, previous coronary bypass surgery, and extent of coronary disease and of abnormal left ventricular function. The Cox regression model of survival showed that independent risk factors for lower survival were older age, previous coronary bypass surgery, previous myocardial infarction, and diabetes. Sex was not an independent risk factor for poorer survival.
Women have a higher operative mortality and lower long-term survival than men after coronary bypass surgery for angina. However, the differences are small, even if statistically significant. Importantly, patient-related factors and not sex are independent predictors of poorer survival. Therefore, coronary bypass surgery should not be delayed or denied to women who have the usual indications for surgery.
女性冠状动脉搭桥手术的生存率低于男性。我们需要了解这是否是由于患者相关因素所致，以及在所有患者亚组和手术进行的所有时间段内是否都存在较低的生存率。
我们采用精算技术，确定了1979例女性和6927例男性因慢性稳定型和不稳定型心绞痛接受冠状动脉搭桥手术的结果。女性手术死亡率为2.7%，男性为1.9%（P = 0.02）。女性中三支或更多血管病变且左心室功能异常者（5.4%对2.8%，P = 0.009）以及稳定型心绞痛患者（2.6%对1.5%，P = 0.006）的手术死亡率较高。女性的5年、10年、15年和18年生存率分别为86±0.9%、70±1.5%、50±2.5%和37±6.4%，男性分别为88±0.4%、73±0.7%、54±1.2%和42±1.9%（P = 0.03）。女性与男性相比，三支或更多血管病变且左心室功能异常者生存率较低（10年时，69±1.8%对73±0.8%，P = 0.005）。15年时，再次手术发生率女性为26±2.4%，男性为28±1.2%；心肌梗死发生率女性为30±2.8%，男性为32±1.3%；两者P值均无统计学意义。无心绞痛或轻度心绞痛发生率女性为70%，男性为78%，P < 0.0001。不同时间段接受手术的女性或男性的手术死亡率和远期生存率无显著差异。女性年龄较大（64±9.4岁对61±
