Department of Cardiac Surgery, I.R.C.C.S. Policlinico San Donato, Milan, Italy.
J Cardiovasc Med (Hagerstown). 2018 Sep;19(9):497-502. doi: 10.2459/JCM.0000000000000659.
Despite several studies reporting a higher mortality rate for women undergoing isolated coronary artery bypass graft (CABG) surgery, this issue has not been completely clarified. The aim of the current study was to determine if sex differences in CABG surgery affect adjusted operative results and operative mortality.
Between January 2005 and December 2012, 3756 consecutive patients (3009 men and 747 women) underwent isolated CABG at our institution. Women presented with older age, smaller BSA and higher rate of preoperative comorbidities. The propensity score methodology was used to obtain risk-adjusted outcome comparisons between the two groups.
The distribution of preoperative variables among matched pairs (553 patients in both groups) was, on average, equal. Propensity-matched women received a similar number of distal anastomoses (P = 0.56), had similar rate of left internal thoracic artery (LITA) graft (P = 0.73) and comparable extracorporeal circulation (P = 0.61) and aortic cross-clamp (P = 0.39) time as men. Postoperative complications were comparable in the two study groups with the exception of postoperative transfusion rate which was significantly higher in women (P = 0.01). However, operative mortality (3.8 vs. 2.7%; P = 0.20), perioperative acute myocardial infarction (P = 0.50) and stroke (P = 0.75) were not significantly different between the two groups. Interestingly, after adjustment for the other baseline characteristics, female patients with diabetes (P = 0.03), preoperative renal dysfunction (P = 0.07) and obesity (P = 0.07) exhibited a greater operative mortality rate compared with men with the same comorbidities.
After adjustment for preoperative variables, female sex seems not to be an independent risk factor for early mortality in isolated CABG surgery. However, renal impairment, diabetes and obesity seem to play an important role in the operative risk profile of women undergoing isolated CABG.
尽管有几项研究报告称女性接受单纯冠状动脉旁路移植术（CABG）的死亡率更高，但这一问题尚未完全阐明。本研究旨在确定 CABG 手术中的性别差异是否会影响校正后的手术结果和手术死亡率。
2005 年 1 月至 2012 年 12 月，我院连续收治 3756 例单纯 CABG 患者（男 3009 例，女 747 例）。女性患者年龄较大，体表面积较小，术前合并症发生率较高。采用倾向评分法对两组患者进行风险校正后手术结果比较。
匹配后的两组患者（每组 553 例）的术前变量分布平均相等。匹配后的女性患者接受的远端吻合术数量相似（P=0.56），左内乳动脉（LITA）移植率相似（P=0.73），体外循环（P=0.61）和主动脉阻断时间相似（P=0.39）与男性患者相同。两组患者术后并发症相当，除女性术后输血率显著较高外（P=0.01）。然而，两组手术死亡率（3.8% vs. 2.7%；P=0.20）、围手术期急性心肌梗死（P=0.50）和中风（P=0.75）均无显著差异。有趣的是，在调整其他基线特征后，患有糖尿病（P=0.03）、术前肾功能不全（P=0.07）和肥胖症（P=0.07）的女性患者的手术死亡率高于患有相同合并症的男性患者。
在调整术前变量后，女性性别似乎不是单纯 CABG 手术早期死亡的独立危险因素。然而，肾功能不全、糖尿病和肥胖症似乎在单纯 CABG 女性患者的手术风险谱中起着重要作用。
