Sumin A N, Korok E V, Gaifulin R A, Ivanov S V, Barbarash O L
Research Institute for Complex Problems of Cardiovascular Diseases, Kemerovo, Russia.
Kardiologiia. 2016 Aug;56(8):33-39. doi: 10.18565/cardio.2016.8.33-39.
To assess the impact of presence of multifocal atherosclerosis (MFA) and gender differences on immediate outcomes after coronary artery bypass grafting (CABG) in patients with ischemic heart disease (IHD).
Medical records of patients with MFA, who underwent elective CABG (n=764, 655 men, 109 women) were reviewed retrospectively.
Women were older (<0.001), and more often were overweight (<0.001), had diabetes (<0.001), high angina functional class (=0.012) and congestive heart failure (=0.002). Cigarette smoking was more common among men. Men more often had reduced left ventricular ejection fraction (<0.001). Three-vessel coronary artery disease prevailed among women (=0.080). Rate of hemodynamically significant carotid stenosis was higher among women (=0.010), whereas that of peripheral artery disease - among men (=0.001). Total number of perioperative complications was 48.8% among women and 53.0% among men (=0.399). According to multivariate analysis, history of CABG was associated with increased risk of perioperative complications (=0.034), and combined involvement of left main coronary artery (LMCA) and three coronary arteries - with in-hospital mortality (=0.003).
There were no gender differences in the incidence of perioperative complications. Women more often had carotid lesions, men - lesions in arteries of lower limbs. Women had more risk factors (other than smoking) what could explain high prevalence of three-vessel disease as well as more severe coronary insufficiency and heart failure. Regardless of patients gender and presence of MFA history of previous CABG and presence of combined LMCA and three coronary arteries involvement increased risk of perioperative complications and in-hospital mortality, respectively.
评估多灶性动脉粥样硬化（MFA）的存在及性别差异对缺血性心脏病（IHD）患者冠状动脉旁路移植术（CABG）后近期结局的影响。
回顾性分析接受择期CABG的MFA患者的病历（n = 764，男性655例，女性109例）。
女性年龄更大（<0.001），超重（<0.001）、患糖尿病（<0.001）、心绞痛功能分级高（= 0.012）和充血性心力衰竭（= 0.002）的情况更常见。吸烟在男性中更常见。男性左心室射血分数降低的情况更常见（<0.001）。三支冠状动脉疾病在女性中更普遍（= 0.080）。血流动力学显著的颈动脉狭窄发生率在女性中更高（= 0.010），而外周动脉疾病在男性中更高（= 0.001）。围手术期并发症总数在女性中为48.8%，在男性中为53.0%（= 0.399）。根据多因素分析，CABG病史与围手术期并发症风险增加相关（= 0.034），左主冠状动脉（LMCA）和三支冠状动脉联合受累与住院死亡率相关（= 0.003）。
围手术期并发症发生率无性别差异。女性更常出现颈动脉病变，男性更常出现下肢动脉病变。女性有更多危险因素（吸烟除外），这可以解释三支血管疾病的高患病率以及更严重的冠状动脉供血不足和心力衰竭。无论患者性别及是否存在MFA，既往CABG病史以及LMCA和三支冠状动脉联合受累分别增加了围手术期并发症风险和住院死亡率。
