Weintraub W S, Wenger N K, Jones E L, Craver J M, Guyton R A
Division of Cardiology, Emory University Hospital, Atlanta, GA 30322.
Circulation. 1993 Nov;88(5 Pt 2):II79-86.
There is uncertainty as to the relative efficacy of coronary artery bypass graft surgery (CABG) in men and women. Differences between sexes may be of greater importance than heretofore because of increased frequency of risk factors for adverse outcome. It is the purpose of this study to examine the changing clinical characteristics of patients undergoing CABG and to determine the influence of these changes on the results of CABG in men and in women.
The source of data was the clinical database at Emory University Hospitals. The population comprised 13,368 patients (2648 women, 10,720 men) who had cardiac catheterization followed by CABG between 1974 and 1991. The patients were divided into the time periods 1974 through 1979 (532 women, 2792 men), 1980 through 1983 (727 women, 3151 men), 1984 through 1987 (695 women, 2619 men), and 1988 through 1991 (694 women, 2158 men). Data were collected prospectively and entered into a computerized database. The women were older (63 +/- 10 versus 58 +/- 10 years, P < .0001) and more frequently had diabetes (26.0% versus 15.4%, P < .0001). The in-hospital mortality was 3.8% in women and 1.6% in men. The multivariate correlates of death were older age, emergent surgery, reduced ejection fraction, female sex, diabetes, and more severe distribution of coronary arterial narrowings. Each of these risk factors for death became more prevalent, such that the mortality in men increased from 1.0% in 1974 through 1979 to 2.7% in 1988 through 1991, whereas the mortality in women increased from 1.3% in 1974 through 1979 to 5.4% in 1988 through 1991.
The population undergoing CABG has aged, with correlates of in-hospital death becoming more common. The higher mortality in women could only partially be explained by other clinical variables. In addition, the risk of death after CABG has increased in women more than in men because women have consistently been older, have more emergent surgery and diabetes, and in recent years more women undergoing CABG have three-vessel or left main disease.
冠状动脉旁路移植术（CABG）在男性和女性中的相对疗效尚不确定。由于不良结局风险因素的频率增加，性别差异可能比以往更为重要。本研究的目的是检查接受CABG患者不断变化的临床特征，并确定这些变化对男性和女性CABG结果的影响。
数据来源是埃默里大学医院的临床数据库。研究人群包括1974年至1991年间接受心脏导管检查并随后接受CABG的13368例患者（2648例女性，10720例男性）。患者被分为1974年至1979年（532例女性，2792例男性）、1980年至1983年（727例女性，3151例男性）、1984年至1987年（695例女性，2619例男性）和1988年至1991年（694例女性，2158例男性）这几个时间段。数据是前瞻性收集并录入计算机化数据库的。女性年龄更大（63±10岁对58±10岁，P<.0001），患糖尿病的频率更高（26.0%对15.4%，P<.0001）。女性住院死亡率为3.8%，男性为1.6%。死亡的多因素相关因素包括年龄较大、急诊手术、射血分数降低、女性性别、糖尿病以及冠状动脉狭窄分布更严重。这些死亡风险因素中的每一个都变得更加普遍，以至于男性死亡率从1974年至1979年的1.0%增加到1988年至1991年的2.7%，而女性死亡率从1974年至1979年的1.3%增加到1988年至1991年的5.4%。
接受CABG的人群年龄增大，住院死亡相关因素变得更加常见。女性较高的死亡率只能部分由其他临床变量解释。此外，CABG后女性的死亡风险增加幅度大于男性，因为女性一直年龄更大，急诊手术和糖尿病更多，并且近年来接受CABG的女性中更多患有三支血管或左主干病变。
