Heart Center, Turku University Hospital, University of Turku, Turku, Finland; Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Center for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland; Administrative Center, Hospital District of Southwest Finland, Turku, Finland.
Department of Neurology, North Karelia Central Hospital, Siun Sote, Joensuu, Finland; Department of Neurology, University of Turku, Turku, Finland.
Ann Thorac Surg. 2021 Dec;112(6):1974-1981. doi: 10.1016/j.athoracsur.2021.01.014. Epub 2021 Jan 20.
Sex is suggested to influence outcomes after coronary artery bypass grafting (CABG), although evidence on long-term mortality is controversial and cardiovascular outcome data are lacking. We studied sex differences in outcomes after isolated CABG.
Consecutive patients with first-time isolated CABG for stable coronary artery disease between 2004 and 2014 in Finland were retrospectively recognized from national registry (n = 14,681; 21% women). Propensity scoring and inverse probability weighting were used to adjust for baseline features. Median follow-up was 10.0 (maximum 14.6) years.
Cumulative major adverse cardiovascular event (myocardial infarction, stroke, or cardiovascular death) rate was 44.5% in men and 49.9% in women during follow-up (hazard ratio [HR], 0.98; P = .633). All-cause mortality was 48.5% in men vs 46.0% in women (HR, 1.20; 95% confidence interval, 1.11-1.30; P < .0001), and cardiovascular mortality was 29.5% vs 31.3% (P = .625). Stroke rate was comparable between men and women (19.4% vs 23.6%; P = .625). Myocardial infarction occurred more frequently in women (20.0% vs 23.6%; HR, 0.84; 95% confidence interval, 0.75-0.95; P = .005). Redo revascularization was performed to 12.8% of women and to 12.6% of men (P = .100). Anticoagulation was more frequently used by men and adenosine diphosphate inhibitors and diuretics were more frequently used by women after CABG. Usage of statins, angiotensin-converting-enzyme inhibitors or angiotensin-blockers, beta-blockers, calcium-channel blockers, or nitrates did not differ between sexes after CABG.
Sex was not an independent predictor of long-term major adverse cardiovascular events after CABG in this population-based cohort study. However, men had higher long-term all-cause mortality and women higher risk of myocardial infarction. Long-term outcomes should be accounted for when considering sex as a risk factor for CABG.
有研究表明，性别会影响冠状动脉旁路移植术（CABG）后的结果，但长期死亡率方面的证据存在争议，且心血管结局数据也较为缺乏。本研究旨在探讨 CABG 术后不同性别之间的结局差异。
回顾性分析了 2004 年至 2014 年期间芬兰全国注册登记处连续收治的因稳定性冠状动脉疾病行初次单纯 CABG 的患者（n=14681，21%为女性）。采用倾向评分和逆概率加权法调整基线特征。中位随访时间为 10.0 年（最长随访 14.6 年）。
随访期间，男性的主要不良心血管事件（心肌梗死、卒中和心血管死亡）累积发生率为 44.5%，女性为 49.9%（风险比 [HR]，0.98；P=.633）。男性全因死亡率为 48.5%，女性为 46.0%（HR，1.20；95%置信区间，1.11-1.30；P <.0001），心血管死亡率为 29.5%，女性为 31.3%（P=.625）。男性和女性的卒中发生率相当（19.4%比 23.6%；P=.625）。女性心肌梗死的发生率更高（20.0%比 23.6%；HR，0.84；95%置信区间，0.75-0.95；P=.005）。女性中有 12.8%接受了血运重建，男性为 12.6%（P=.100）。CABG 后，男性更常使用抗凝药物，而女性更常使用二磷酸腺苷抑制剂和利尿剂。CABG 后，男女使用他汀类药物、血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂、β受体阻滞剂、钙通道阻滞剂或硝酸盐的情况没有差异。
在这项基于人群的队列研究中，性别不是 CABG 后长期发生主要不良心血管事件的独立预测因素。然而，男性的长期全因死亡率更高，而女性发生心肌梗死的风险更高。在考虑性别是否为 CABG 的危险因素时，应考虑长期结局。
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