Mack Michael J, Brown Phillip, Houser Frank, Katz Mark, Kugelmass Aaron, Simon April, Battaglia Salvatore, Tarkington Lynn, Culler Steven, Becker Edmund
HCA, Inc, Nashville, Tenn, USA.
Circulation. 2004 Sep 14;110(11 Suppl 1):II1-6. doi: 10.1161/01.CIR.0000138198.62961.41.
Women have consistently higher mortality and morbidity than men after coronary artery bypass grafting (CABG). Whether elimination of cardiopulmonary bypass and performance of coronary artery bypass grafting off-pump (OPCAB) have a beneficial effect specifically in women has not been defined.
From January 1998 through March 2002, 21 902 consecutive female patients at 82 hospitals underwent isolated CABG, as reported in an administrative database. Propensity score computer matching was performed based on 13 variables representing patient characteristics and preoperative risk factors to correct for and minimize selection bias. A total of 7376 (3688 pairs) women undergoing CABG surgery were able to be successfully matched. In a propensity score computer-matched cohort, multivariate logistic regression (odds ratio) revealed that women undergoing on-pump surgery had a 73.3% higher mortality (P=0.002) and a 47.2% higher risk of bleeding complications (P=0.019).
In a retrospective analysis of women undergoing CABG, computer-matched to minimize selection bias, off-pump surgery led to decreased mortality and morbidity including bleeding complications.
冠状动脉旁路移植术（CABG）后，女性的死亡率和发病率一直高于男性。消除体外循环并进行非体外循环冠状动脉旁路移植术（OPCAB）是否对女性有特别有益的影响尚未明确。
据一个管理数据库报告，1998年1月至2002年3月期间，82家医院的21902例连续女性患者接受了单纯CABG。基于代表患者特征和术前危险因素的13个变量进行倾向评分计算机匹配，以校正并最小化选择偏倚。共有7376例（3688对）接受CABG手术的女性能够成功匹配。在倾向评分计算机匹配队列中，多因素逻辑回归（比值比）显示，接受体外循环手术的女性死亡率高73.3%（P=0.002），出血并发症风险高47.2%（P=0.019）。
在一项对接受CABG的女性进行的回顾性分析中，通过计算机匹配以最小化选择偏倚，非体外循环手术降低了包括出血并发症在内的死亡率和发病率。
