Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
J Thorac Cardiovasc Surg. 2022 Feb;163(2):686-695.e10. doi: 10.1016/j.jtcvs.2020.04.058. Epub 2020 Apr 23.
Double arterial conduit use during coronary artery bypass grafting is associated with improved clinical outcomes compared with single arterial conduits in the general population. However, the sex-specific outcomes of this strategy remain unknown and are needed to inform sex-specific revascularization guidelines.
We conducted a population-based, retrospective cohort study of all Ontarians who underwent primary isolated coronary artery bypass grafting with single arterial conduits or double arterial conduits between October 2008 and September 2017. The primary outcome was all-cause mortality. Secondary outcomes included major adverse cardiac and cerebrovascular events, defined as a composite of myocardial infarction, heart failure hospitalization, repeat revascularization, and stroke. We used inverse probability of treatment weighting to account for group imbalances.
A total of 9135 women and 36,748 men underwent coronary artery bypass grafting. At 30 days, there was no between-group difference in mortality or major adverse cardiac and cerebrovascular events in men. However, among women, a double arterial conduit was associated with an increased rate of 30-day death (hazard ratio, 1.48; 95% confidence interval, 1.23-1.79) and major adverse cardiac and cerebrovascular events (hazard ratio, 1.32; 95% confidence interval, 1.14-1.51). The risk of medium-term mortality with double arterial conduits was less in men (hazard ratio, 0.88; 95% confidence interval, 0.84-0.92) and women (hazard ratio, 0.87; 95% confidence interval, 0.81-0.94), as was the medium-term risk of major adverse cardiac and cerebrovascular events (hazard ratio, 0.91; 95% confidence interval, 0.87-0.94) [men]; hazard ratio, 0.91; 95% confidence interval, 0.86-0.97) [women]). The incremental improvement in 9-year survival was 4.0% in women with a double arterial conduit and 0.9% in men.
Double arterial conduit is associated with better medium-term survival and cardiovascular outcomes in both sexes. Double arterial conduits are associated with increased perioperative risk in women, but the medium-term benefit is greater than in men.
与单动脉移植物相比，在普通人群中，冠状动脉旁路移植术中使用双动脉移植物与改善临床结局相关。然而，这种策略的性别特异性结果尚不清楚，需要为性别特异性血运重建指南提供信息。
我们对 2008 年 10 月至 2017 年 9 月期间接受单动脉移植物或双动脉移植物行单纯冠状动脉旁路移植术的所有安大略省患者进行了一项基于人群的回顾性队列研究。主要结局是全因死亡率。次要结局包括主要不良心脏和脑血管事件，定义为心肌梗死、心力衰竭住院、再次血运重建和卒中的复合结局。我们使用逆概率治疗加权来纠正组间不平衡。
共 9135 名女性和 36748 名男性接受了冠状动脉旁路移植术。在 30 天内，男性在死亡率或主要不良心脏和脑血管事件方面两组之间无差异。然而，在女性中，双动脉移植物与 30 天死亡（风险比，1.48；95%置信区间，1.23-1.79）和主要不良心脏和脑血管事件（风险比，1.32；95%置信区间，1.14-1.51）发生率增加相关。在男性（风险比，0.88；95%置信区间，0.84-0.92）和女性（风险比，0.87；95%置信区间，0.81-0.94）中，使用双动脉移植物的中期死亡率风险较低，主要不良心脏和脑血管事件（风险比，0.91；95%置信区间，0.87-0.94）的中期风险也较低[男性]；风险比，0.91；95%置信区间，0.86-0.97）[女性]）。在女性中，使用双动脉移植物的 9 年生存率的增量改善为 4.0%，在男性中为 0.9%。
在两性中，双动脉移植物与更好的中期生存和心血管结局相关。双动脉移植物在女性中与围手术期风险增加相关，但中期获益大于男性。
