Department of Cardiac Surgery, Instituto Cardiovascular De Buenos Aires, Buenos Aires, Argentina.
Department of Cardiac Surgery, Instituto Cardiovascular De Buenos Aires, Buenos Aires, Argentina.
J Thorac Cardiovasc Surg. 2019 Nov;158(5):1345-1353.e1. doi: 10.1016/j.jtcvs.2019.01.025. Epub 2019 Jan 23.
Mortality after coronary artery bypass grafting (CABG) has been reported to be higher in women. The aim of this study was to evaluate whether bilateral internal thoracic artery (BITA) grafting in women has a long-term survival benefit over single internal thoracic artery grafting, possibly equivalent to the male population.
A retrospective review was undertaken of our prospectively collected database. We included 4406 consecutive patients who underwent isolated CABG, who received their operation between January 2000 and April 2017. From the entire series, 2979 patients (67.6%) received exclusively BITA grafts; 299 (10.1%) were female. The primary end point was follow-up mortality, independently from cause. In-hospital mortality and during follow-up were analyzed. Substratification according to age was performed to answer whether it has an effect. Multivariable Cox proportional hazard analyses was performed to investigate the significant predictors of late mortality.
The median follow-up was 5.1 ± 3.9 years. Female BITA patients were older (P < .001), had nonelective surgery (P < .001), more on-pump CABG (P = .015), fewer number of grafts (P < .001) versus male BITA patients. BITA grafting in women had a long-term survival equivalent to that of men (P = .784). In a Cox proportional hazard model, female sex was not an independent risk factor for late death (B, -0.303; hazard ratio, 0.739; 95% confidence interval, 0.470-1.16; P = .189). The stratification analysis showed that the beneficial effect of BITA remained similar among sexes and was not modified by age even after adjusting for confounders. In a risk-adjusted sample, patients older than 65 years with BITA grafting showed superior long-term survival than those with single internal thoracic artery grafting (P = .019).
Although there are some differences between sexes, BITA grafting in women was associated with similar 10-year survival compared with men, and female sex was not an independent risk factor for late death. Among women, the BITA group had better survival, especially those older than 65 years.
据报道，女性行冠状动脉旁路移植术（CABG）后的死亡率较高。本研究旨在评估女性双侧胸廓内动脉（BITA）移植是否比男性具有长期生存获益，可能与男性相当。
对我们前瞻性收集的数据库进行回顾性分析。纳入 2000 年 1 月至 2017 年 4 月期间行单纯 CABG 的 4406 例连续患者。在整个系列中，2979 例（67.6%）患者接受了单纯 BITA 移植；299 例（10.1%）为女性。主要终点是随访死亡率，与病因无关。分析住院死亡率和随访期间死亡率。根据年龄进行分层，以回答其是否有影响。采用多变量 Cox 比例风险分析探讨晚期死亡率的显著预测因素。
中位随访时间为 5.1±3.9 年。女性 BITA 患者年龄更大（P<.001），择期手术比例更低（P<.001），非体外循环 CABG 比例更高（P=.015），吻合支数量更少（P<.001）。女性 BITA 移植患者的长期生存率与男性相当（P=.784）。在 Cox 比例风险模型中，女性性别不是晚期死亡的独立危险因素（B，-0.303；风险比，0.739；95%置信区间，0.470-1.16；P=.189）。分层分析显示，即使在调整混杂因素后，这种 BITA 的有益作用在性别间仍相似，且不受年龄影响。在风险调整样本中，年龄大于 65 岁且接受 BITA 移植的患者的长期生存率优于接受单支胸廓内动脉移植的患者（P=.019）。
尽管男女之间存在一些差异，但女性 BITA 移植与男性相比，10 年生存率相似，女性性别不是晚期死亡的独立危险因素。在女性中，BITA 组的生存率更好，尤其是年龄大于 65 岁的患者。
