Gaudino Mario, Samadashvili Zaza, Hameed Irbaz, Chikwe Joanna, Girardi Leonard N, Hannan Edward L
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.
Department of Health Policy, University at Albany School of Public Health, Albany, New York.
JAMA Cardiol. 2021 Apr 1;6(4):401-409. doi: 10.1001/jamacardio.2020.6585.
Sex-related differences in the outcome of using multiple arterial grafts during coronary artery bypass grafting (CABG) remain uncertain.
To compare the outcomes of the use of multiple arterial grafts vs a single arterial graft during CABG for women and men.
DESIGN, SETTING, AND PARTICIPANTS: This statewide cohort study used data from New York's Cardiac Surgery Reporting System and New York's Vital Statistics file on 63 402 patients undergoing CABG from January 1, 2005, to December 31, 2014. Statistical analysis was performed from January 10 to August 20, 2020.
Multiple arterial grafting or single arterial grafting.
Mortality, acute myocardial infarction (AMI), stroke, repeated revascularization, major adverse cardiac and cerebrovascular event (composite of mortality, AMI, and stroke), and major adverse cardiac event (composite of mortality, AMI, or repeated revascularization) were compared among propensity-matched patients and stratified by the risk of long-term mortality.
Of the 63 402 patients (48 155 men [76.0%]; mean [SD] age, 69.9 [10.5] years) in the study, women had worse baseline characteristics than men for most of the explored variables. Propensity matching yielded a total of 9512 male pairs and 1860 female pairs. At 7 years of follow-up, mortality was lower among men who underwent multiple arterial grafting (adjusted hazard ratio, 0.80; 95% CI, 0.73-0.87) but not women who underwent multiple arterial grafting (adjusted hazard ratio, 0.99; 95% CI, 0.84-1.15). When stratified by the estimated risk of death, the use of multiple arterial grafts was associated with better survival and a lower rate of a major adverse cardiac event among low-risk, but not high-risk, patients of both sexes, and the risk cutoff was different for men and women.
This study suggests that women have a worse preoperative risk profile than men. Multiple arterial grafting is associated with better outcomes among low-risk, but not high-risk, patients, and the risk cutoffs differ between sexes. These data highlight the need for new studies on the outcome of multiple arterial grafts in women.
冠状动脉旁路移植术（CABG）中使用多条动脉移植物的结果与性别相关的差异仍不明确。
比较女性和男性在CABG期间使用多条动脉移植物与单条动脉移植物的结果。
设计、地点和参与者：这项全州范围的队列研究使用了纽约心脏手术报告系统和纽约生命统计文件中2005年1月1日至2014年12月31日期间63402例接受CABG患者的数据。统计分析于2020年1月10日至8月20日进行。
多条动脉移植或单条动脉移植。
在倾向评分匹配的患者中比较死亡率、急性心肌梗死（AMI）、中风、再次血运重建、主要不良心脑血管事件（死亡率、AMI和中风的综合）以及主要不良心脏事件（死亡率、AMI或再次血运重建的综合），并按长期死亡风险分层。
在该研究的63402例患者（48155例男性[76.0%]；平均[标准差]年龄，69.9[10.5]岁）中，对于大多数探索的变量，女性的基线特征比男性差。倾向评分匹配共产生9512对男性和1860对女性。在7年的随访中，接受多条动脉移植的男性死亡率较低（调整后的风险比，0.80；95%置信区间，0.73-0.87），但接受多条动脉移植的女性并非如此（调整后的风险比，0.99；95%置信区间，0.84-1.15）。按估计的死亡风险分层时，对于低风险而非高风险的男女患者，使用多条动脉移植物与更好的生存率和更低的主要不良心脏事件发生率相关，且男女的风险临界值不同。
本研究表明，女性术前风险状况比男性差。多条动脉移植与低风险而非高风险患者的更好结局相关，且性别间的风险临界值不同。这些数据凸显了对女性多条动脉移植物结果进行新研究的必要性。
