Ter Woorst J F, Hoff A H T, Haanschoten M C, Houterman S, van Straten A H M, Soliman-Hamad M A
Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands.
Department of Anaesthesiology, and Intensive Care Unit, Catharina Hospital, Eindhoven, The Netherlands.
Neth Heart J. 2019 Dec;27(12):629-635. doi: 10.1007/s12471-019-01333-9.
Outcomes after coronary artery bypass grafting (CABG) are worse in women than in men. This study aims to investigate whether off-pump coronary artery bypass (OPCAB) surgery improves the outcomes in women by comparing different outcome measures in both genders.
Patients who underwent isolated CABG, either on-pump (ONCAB) or OPCAB, between January 1998 and June 2017 were included. Primary endpoints were 30-day and 120-day mortality. Logistic regression models were constructed to evaluate the effect of the CABG technique on important outcomes such as mortality and the need for blood transfusion.
The data of 17,052 patients were analysed, 3,684 of whom were women (414 OPCAB) and 13,368 men (1,483 OPCAB). The mean number of grafts was lower in the OPCAB group of both genders (p < 0.001). Postoperatively, both men and women undergoing OPCAB surgery received fewer red blood cell transfusions (p < 0.001) and had higher postoperative haemoglobin levels (p < 0.001) than those undergoing ONCAB. Early mortality occurred less frequently after OPCAB surgery in both genders, although the difference was not significant. However, 120-day mortality was significantly lower after OPCAB surgery in women, even after correction for preoperative risk factors [odds ratio (OR) = 0.356, 95% confidence interval (CI) 0.144-0.882, p = 0.026]. The difference in 120-day mortality was not significant in men (OR = 0.787, 95% CI 0.498-1.246, p = 0.307).
Women undergoing CABG benefit more from OPCAB surgery than from ONCAB surgery in terms of 120-day mortality. This difference was not found in men in our patient population.
冠状动脉旁路移植术（CABG）后女性的预后比男性差。本研究旨在通过比较男女不同的预后指标，调查非体外循环冠状动脉旁路移植术（OPCAB）是否能改善女性的预后。
纳入1998年1月至2017年6月期间接受单纯CABG的患者，包括体外循环（ONCAB）或OPCAB手术。主要终点为30天和120天死亡率。构建逻辑回归模型以评估CABG技术对死亡率和输血需求等重要预后的影响。
分析了17052例患者的数据，其中女性3684例（414例行OPCAB），男性13368例（1483例行OPCAB）。两组性别中OPCAB组的平均移植血管数均较低（p<0.001）。术后，接受OPCAB手术的男性和女性比接受ONCAB手术的患者接受的红细胞输血更少（p<0.001），术后血红蛋白水平更高（p<0.001）。两组性别中OPCAB手术后早期死亡率均较低，尽管差异不显著。然而，女性OPCAB手术后120天死亡率显著降低，即使在校正术前危险因素后[比值比（OR）=0.356，95%置信区间（CI）0.144 - 0.882，p = 0.026]。男性120天死亡率差异不显著（OR = 0.787，95% CI 0.498 - 1.246，p = 0.307）。
就120天死亡率而言，接受CABG的女性从OPCAB手术中获益比ONCAB手术更多。在我们的患者群体中，男性未发现这种差异。
