INFLUENCE OF GENDER ON CARDIAC RISK AND SURVIVAL IN PATIENTS WITH INFRARENAL AORTIC-ANEURYSMS

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.