Περίληψη:
Objective: 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.
Methods: 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.
Results: 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, >= 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.
Conclusions: Despite equality between sexes in early outcome and
superiority of female sex in long-term survival, there were 3
independent predictors for long-term 1 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.
Συγγραφείς:
Toumpoulis, IK
Anagnostopoulos, CE
Balaram, SK
Rokkas, CK
and Swistel, DG
Ashton, RC
DeRose, JJ
