Je. Starr et al., INFLUENCE OF GENDER ON CARDIAC RISK AND SURVIVAL IN PATIENTS WITH INFRARENAL AORTIC-ANEURYSMS, Journal of vascular surgery, 23(5), 1996, pp. 870-880
Purpose: TO determine whether gender distinctions influence the cardia
c risk or survival rates associated with surgical treatment of infrare
nal abdominal aortic aneurysms (AAAs). Methods: From 1983 to 1988, gra
ft replacement of intact intact AAAs was performed in 490 men (84%) an
d in 99 women (16%) who had no history of myocardial revascularization
before the discovery of their AAAs. Patients of both genders were com
parable with respect to mean age (68 years) and the prevalence of-coro
nary artery disease (CAD) by standard clinical criteria (men, 73%; wom
en, 65%). Preoperative coronary angiography was obtained in 471 of the
582 patients (men, 81%; women, 80%) during this particular study peri
od. Preliminary coronary bypass was warranted on the basis of existing
indications in 211 (24%) of these 471 patients (men, 25%; women, 18%)
, including 104 (31%) of the 337 who had clinical indications of CAD (
men, 32%; women, 26%) but only 7 (5.2%) of the 134 who did not (men, 6
%; women, 4%). Follow-up data were collected during a mean interval of
53 months (men, 54 months; women, 48 months) and were analyzed by Kap
lan-Meier survival analysis and Cox proportional hazards models. Resul
ts: Twenty-nine perioperative deaths (5.0%) occurred in. conjunction w
ith AAA repair (men, 5.1%; women, 4.3%), and 126 early and late deaths
have occurred (men, 22%; women, 22%). Survival rates for the series w
ere found to correlate with age (p < 0.001), the serum creatinine leve
l (p < 0.001), and the coronary angiographic classification (p < 0.001
). No significant differences were identified between the gender cohor
ts. The cardiac mortality rate for AAA resection was only 1.8% in the
111 patients who had preliminary coronary bypass, but five additional
perioperative deaths (4.5%) related to renal failure or sepsis occurre
d in this group. However, 5-year survival rates for patients receiving
preliminary bypass (men, 82%; women, 75%) were closely comparable wit
h those for patients found to have only mild to moderate CAD by angiog
raphy (men, 86%; women, 82%). Conclusion: We conclude that men and wom
en with AAAs have similar cardiac risks and survival rates associated
with surgical treatment. Our results also illustrate that the potentia
l benefit of coronary intervention for severe CAD in patients of eithe
r gender must be considered in the context of long-term outcome and th
e early mortality rate of AAA repair.