Gender-specific predictors of early mortality after coronary artery bypass graft surgery
Gender-specific predictors of early mortality after coronary artery bypass graft surgery
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DOI：
10.1007/s00392-012-0454-0
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发表时间：
2012-09-01
影响因子：
5
通讯作者：
Regitz-Zagrosek, V.
中科院分区：
文献类型：
--
作者：
Lehmkuhl, E.;Kendel, F.;Regitz-Zagrosek, V.
女性是冠状动脉旁路移植术（CABG）后早期死亡的危险因素。然而，妇女死亡率过高的原因尚未得到充分解释。（手术后30天），并确定解释女性性别与超额死亡率之间相关性的变量，同时考虑术前临床和心理社会，手术和术后风险因素。本前瞻性研究纳入了柏林德国心脏研究所（2005-2008年）收治的559例接受CABG的连续患者。对术前、手术和术后的一系列危险因素进行分析，发现女性冠状动脉旁路移植术后的早期死亡率高于男性（6.9%vs.2.4%，HR2.91，95%CI 1.70-4.96，P < 0.001）。妇女比男子年龄大（+4.7岁，P < 0.001），术前自我评估的身体功能较低（0 ~ 100分-16分，P < 0.001），术后低心排综合征发生率较高（6.6 vs. 3.3%，P = 0.01）、呼吸功能不全（9.4 vs. 5.3%，P = 0.006）和复苏（5.2 vs. 1.8%，P = 0.001）。这些因素的组合解释了早期死亡率中71%的性别差异;年龄和身体功能单独占61%。调整这些变量后，女性的HR为1.36（95%CI 0.77-2.41，P = 0.29）。年龄、身体功能和术后并发症是女性冠状动脉搭桥术后死亡率高的关键因素。在术前风险评估中，应更认真地考虑自我评估的身体功能，特别是女性。
Female gender is a risk factor for early mortality after coronary artery bypass graft surgery (CABG). Yet, the causes for this excess mortality in women have not been fully explained.To analyse gender differences in early mortality (30 days post surgery) after CABG and to identify variables explaining the association between female gender and excess mortality, taking into account preoperative clinical and psychosocial, surgical and postoperative risk factors.A total of 1,559 consecutive patients admitted to the German Heart Institute Berlin (2005-2008) for CABG were included in this prospective study. A comprehensive set of prespecified preoperative, surgical and postoperative risk factors were examined for their ability to explain the gender difference in early mortality.Early mortality after CABG was higher in women than in men (6.9 vs. 2.4 %, HR 2.91, 95 % CI 1.70-4.96, P < 0.001). Women were older than men (+4.7 years, P < 0.001), had lower self-assessed preoperative physical functioning (-16 points on a scale from 0 to 100, P < 0.001), and had higher rates of postoperative low cardiac output syndromes (6.6 vs. 3.3 %, P = 0.01), respiratory insufficiency (9.4 vs. 5.3 %, P = 0.006) and resuscitation (5.2 vs. 1.8 %, P = 0.001). The combination of these factors explained 71 % of the gender difference in early mortality; age and physical functioning alone accounted for 61 %. Adjusting for these variables, HR for female gender was 1.36 (95 % CI 0.77-2.41, P = 0.29).Age, physical function and postoperative complications are key mediators of the overmortality of women after aortocoronary bypass surgery. Self-assessed physical functioning should be more seriously considered in preoperative risk assessment particularly in women.