Division of Cardiac Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
ICES, Toronto, Ontario, Canada.
Heart. 2021 Jun;107(11):888-894. doi: 10.1136/heartjnl-2020-317737. Epub 2020 Oct 20.
Multiple arterial grafting (MAG) in coronary artery bypass grafting (CABG) is associated with higher survival and freedom from major adverse cardiac and cerebrovascular events (MACCEs) in observational studies of mostly men. It is not known whether MAG is beneficial in women. Our objectives were to compare the long-term clinical outcomes of MAG versus single arterial grafting (SAG) in women undergoing CABG for multivessel disease.
Clinical and administrative databases for Ontario, Canada, were linked to obtain all women with angiographic evidence of left main, triple or double vessel disease undergoing isolated non-emergent primary CABG from 2008 to 2019. 1:1 propensity score matching was performed. Late mortality and MACCE (composite of stroke, myocardial infarction, repeat revascularisation and death) were compared between the matched groups with a stratified log-rank test and Cox proportional-hazards model.
2961 and 7954 women underwent CABG with MAG and SAG, respectively, for multivessel disease. Prior to propensity-score matching, compared with SAG, those who underwent MAG were younger (66.0 vs 68.9 years) and had less comorbidities. After propensity-score matching, in 2446 well-matched pairs, there was no significant difference in 30-day mortality (1.6% vs 1.8%, p=0.43) between MAG and SAG. Over a median and maximum follow-up of 5.0 and 11.0 years, respectively, MAG was associated with greater survival (HR 0.85, 95% CI 0.75 to 0.98) and freedom from MACCE (HR 0.85, 95% CI 0.76 to 0.95).
MAG was associated with greater survival and freedom from MACCE and should be considered for women with good life expectancy requiring CABG.
在大多数为男性的观察性研究中，冠状动脉旁路移植术（CABG）中采用多支动脉搭桥（MAG）与更高的生存率和免于主要不良心脏和脑血管事件（MACCE）相关。目前尚不清楚 MAG 是否对女性有益。我们的目的是比较 MAG 与单支动脉搭桥（SAG）在女性多支血管病变行 CABG 中的长期临床结局。
将加拿大安大略省的临床和行政数据库进行链接，以获取 2008 年至 2019 年间所有经血管造影证实左主干、三支或双支血管疾病并接受择期非紧急性原发性 CABG 的女性患者的临床资料。采用 1:1 倾向评分匹配。采用分层对数秩检验和 Cox 比例风险模型比较匹配组之间的晚期死亡率和 MACCE（包括卒中和心肌梗死、再次血运重建和死亡）。
2961 名女性接受 MAG 治疗，7954 名女性接受 SAG 治疗，用于多支血管疾病。在进行倾向评分匹配之前，与 SAG 相比，MAG 组患者年龄更小（66.0 岁 vs 68.9 岁）且合并症更少。在 2446 对匹配良好的患者中，MAG 与 SAG 之间 30 天死亡率无显著差异（1.6% vs 1.8%，p=0.43）。在中位和最大随访时间分别为 5.0 年和 11.0 年期间，MAG 与更好的生存率（HR 0.85，95%CI 0.75 至 0.98）和免于 MACCE（HR 0.85，95%CI 0.76 至 0.95）相关。
MAG 与更好的生存率和免于 MACCE 相关，对于预期寿命较长且需要 CABG 的女性应考虑采用。
