Memphis Veterans Affairs Medical Center, and University of Tennessee Health Sciences Center 1030 Jefferson Avenue, Memphis, TN 38104, USA.
Int J Cardiol. 2013 Jul 15;167(1):180-4. doi: 10.1016/j.ijcard.2011.12.047. Epub 2012 Jan 10.
There is conflicting evidence about the impact of gender on outcomes after coronary artery bypass grafting (CABG).
We performed a multivariate logistic regression and propensity score matched analyses in 13,115 patients (75% men) who underwent CABG between January 1, 1995 and December 31, 2009. The primary outcome was in-hospital mortality. Secondary outcomes included post-operative respiratory failure, stroke, myocardial infarction, sternal and leg wound infections, atrial fibrillation (AF), renal failure, need for postoperative intra-aortic balloon pump (IABP) support, and length of hospital stay.
A higher proportion of women (184; 5.6%) suffered in-hospital death compared to men (264; 2.7%), p<0.0001. After propensity score matching (n=3600 total, 1800 in each group), female gender was an independent predictor of mortality after isolated CABG (odds ratio [OR]=1.84; 95% confidence interval [CI] 1.22-2.78). Women also experienced a higher incidence of postoperative complications including stroke (3.8% vs. 2.3%, OR 1.37; 95% CI 1.08-1.73) and leg wound infection (3.4% vs. 1.7%, OR 1.75; 95% CI 1.36-2.54) on multivariate regression analyses. However, these differences were not significant after propensity score matching. We also observed a lower risk of post-operative AF (21.2% vs. 22.1%, OR 0.78; 95% CI 0.70-0.86) in women that remained significant after propensity matching (O.R. 0.76; 95% C.I. 0.65-0.90). Length of hospital stay was longer in women compared with men (11.9 ± 9.0 vs. 10.4 ± 9.2 days, p<0.0001).
Female gender is an independent predictor of increased mortality and a lower incidence of post-operative AF after isolated CABG.
关于性别对冠状动脉旁路移植术（CABG）后结局的影响，目前存在相互矛盾的证据。
我们对 1995 年 1 月 1 日至 2009 年 12 月 31 日期间接受 CABG 的 13115 例患者（75%为男性）进行了多变量逻辑回归和倾向评分匹配分析。主要结局是住院期间死亡率。次要结局包括术后呼吸衰竭、中风、心肌梗死、胸骨和腿部伤口感染、心房颤动（AF）、肾功能衰竭、术后需要主动脉内球囊泵（IABP）支持以及住院时间。
与男性（264 例，2.7%）相比，更多的女性（184 例，5.6%）发生院内死亡，p<0.0001。在进行倾向评分匹配后（共 3600 例，每组 1800 例），女性性别是单纯 CABG 后死亡率的独立预测因素（优势比[OR]=1.84；95%置信区间[CI]1.22-2.78）。女性还经历了更高的术后并发症发生率，包括中风（3.8%比 2.3%，OR 1.37；95%CI 1.08-1.73）和腿部伤口感染（3.4%比 1.7%，OR 1.75；95%CI 1.36-2.54），这在多变量回归分析中也得到了证实。然而，在倾向评分匹配后，这些差异并不显著。我们还观察到女性术后心房颤动（AF）的风险较低（21.2%比 22.1%，OR 0.78；95%CI 0.70-0.86），在倾向匹配后仍然显著（OR 0.76；95%CI 0.65-0.90）。与男性相比，女性的住院时间更长（11.9±9.0 比 10.4±9.2 天，p<0.0001）。
女性性别是单纯 CABG 后死亡率增加和术后 AF 发生率降低的独立预测因素。
