在冠状动脉搭桥术后，桡动脉对男性和女性均具有保护作用——桡动脉通畅性研究的一项子研究。
The radial artery is protective in women and men following coronary artery bypass grafting-a substudy of the radial artery patency study.
作者信息
Tam Derrick Y, Deb Saswata, Nguyen Bao, Ko Dennis T, Karkhanis Reena, Moussa Fuad, Fremes Jaclyn, Cohen Eric A, Radhakrishnan Sam, Fremes Stephen E
机构信息
Division of Cardiac Surgery, Schulich Heart Centre, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
出版信息
Ann Cardiothorac Surg. 2018 Jul;7(4):492-499. doi: 10.21037/acs.2018.05.19.
BACKGROUND
Studies have demonstrated that female sex is an adverse risk factor in CABG. The primary aim of this study was to determine whether the radial artery (RA) was associated with reduced angiographic occlusion compared to the saphenous vein graft (SVG) stratified by sex in the multi-centered Radial Artery Patency Study (NCT00187356).
METHODS
Between 1996-2001, 529 patients less than 80 years, with graftable triple-vessel disease underwent isolated CABG across 11 centers with late angiographic and clinical follow-up. The primary objective was to compare complete occlusion of RA and SVG with respect to sex. The secondary objective was to determine cumulative patency of both grafts along with predictors of late graft occlusion stratified by sex. The additional objective was to compare major adverse cardiac events (MACE, defined as cardiac mortality, myocardial infarction or re-intervention) between women and men.
RESULTS
Of the 529 enrolled patients (13.4% women), 269 (women: n=41, 15.2%) underwent late angiography at a mean of 7.7±1.5 years after CABG. Women were older (64.1±6.7 versus 59.1±8.0 years, P<0.01) with a higher rate of diabetes (43.9% versus 28.5%, P=0.05). Smoking history was less common (48.8% versus 75.4%, P<0.01) while the mean number of grafts per patient were similar (women: 3.8±0.7, men: 3.8±0.6, P=0.65). RA occlusions were lower than SVG in women (RA: 9.8%, SVG: 26.8%, P=0.05) and in men (RA: 8.8%, SVG: 17.1%, P=0.01). The rate of RA and SVG occlusion was not statistically different between women and men, and cumulative patency curves were also similar between sexes for the RA and study SVG. Multivariable modeling showed that having a RA (versus SVG) was protective in women [odds ratio (OR) 0.15, P=0.04] and men: (OR 0.49, P=0.02). MACE (P=0.15) and event-free cardiac survival (log-rank P=0.14) were similar between women and men.
CONCLUSIONS
Radial arteries are protective in both women and men with comparable burden of coronary disease and revascularization.
背景
研究表明，女性是冠状动脉旁路移植术（CABG）的不良风险因素。本研究的主要目的是在多中心桡动脉通畅性研究（NCT00187356）中，确定按性别分层时，与大隐静脉移植血管（SVG）相比，桡动脉（RA）是否与血管造影闭塞率降低相关。
方法
1996年至2001年间，529例年龄小于80岁、患有可移植三支血管病变的患者在11个中心接受了单纯CABG手术，并进行了晚期血管造影和临床随访。主要目的是比较RA和SVG在性别方面的完全闭塞情况。次要目的是确定两种移植血管的累积通畅率以及按性别分层的晚期移植血管闭塞的预测因素。额外目的是比较女性和男性之间的主要不良心脏事件（MACE，定义为心脏死亡、心肌梗死或再次干预）。
结果
在529例入组患者中（13.4%为女性），269例（女性：n = 41，15.2%）在CABG术后平均7.7±1.5年接受了晚期血管造影。女性年龄更大（64.1±6.7岁 vs 59.1±8.0岁，P<0.01），糖尿病发生率更高（43.9% vs 28.5%，P = 0.05）。吸烟史较少见（48.8% vs 75.4%，P<0.01），而每位患者的平均移植血管数量相似（女性：3.8±0.7，男性：3.8±0.6 , P = 0.65）。女性中RA闭塞低于SVG（RA：9.8%，SVG：26.8%，P = 0.05），男性中也是如此（RA：8.8%，SVG：17.1%，P = 0.01）。女性和男性之间RA和SVG闭塞率无统计学差异，RA和研究中的SVG在性别之间的累积通畅曲线也相似。多变量建模显示，使用RA（相对于SVG）对女性具有保护作用[比值比（OR）0.15，P = 0.04]，对男性也是如此：（OR 0.49，P = 0.02）。女性和男性之间的MACE（P = 0.15）和无事件心脏生存率（对数秩检验P = 0.14）相似。
结论
对于冠心病和血运重建负担相当的女性和男性，桡动脉均具有保护作用。
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