Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Medicine, Upstate Medical Center, Syracuse, NY, USA.
J Stroke Cerebrovasc Dis. 2021 May;30(5):105659. doi: 10.1016/j.jstrokecerebrovasdis.2021.105659. Epub 2021 Feb 20.
Prior studies examining sex-related risk of readmission for ischemic stroke (IS) after coronary artery bypass grafting (CABG) did not adjust for preoperative comorbidities and used small study samples that were single-center or otherwise poorly generalizable. We assessed risk of readmission for IS after CABG for females compared to males in a nationwide sample.
The 2013 Nationwide Readmissions Database contains data on 49% of all U.S. hospitalizations. We used population weighting to determine national estimates. Using all follow-up data up to 1 year after discharge from CABG hospitalization, we estimated Kaplan-Meier cumulative risk of IS, stratified by sex, using the log-rank test for significance. We created Cox proportional hazard models to calculate hazard ratios (HR) and 95% confidence intervals (CI) for IS readmission, with sex as the main independent variable. We ran unadjusted models and models adjusted for age, vascular risk factors, estimated severity of illness and risk of mortality, hospital characteristics, and income quartile of patient's zip code.
An estimated 53,270 females and 147,396 males survived index CABG admission in 2013. There was a consistently elevated cumulative risk of readmission for IS after CABG for females versus males (log-rank p-value = 0.0014). In the unadjusted Cox model, the HR of IS in females vs. males was 1.35 (95% CI 1.12-1.62, p = 0.0015). The elevated risk for females remained after adjusting for severity of illness (1.30 [1.08-1.56], p = 0.0056) and risk of mortality (1.28 [1.07-1.54], p = 0.0086). This elevated risk persisted after adjusting for multiple vascular risk factors, hospital characteristics, and income quartile of patient's zip code (1.23 [1.02-1.48], p = 0.03).
We found a 23% increased risk of readmission for IS up to 1 year after CABG for females compared to males in a fully adjusted model utilizing a large, contemporary, nationwide database. Further research would clarify mechanisms of this increased risk among women.
先前研究在评估冠状动脉旁路移植术（CABG）后缺血性中风（IS）的女性再入院风险时，并未对术前合并症进行调整，且使用的研究样本较小，为单中心或其他难以推广的研究。我们在全国性样本中评估了 CABG 后女性与男性的 IS 再入院风险。
2013 年全国再入院数据库包含了 49%的全美住院数据。我们使用人群加权法来确定全国性的估计值。使用出院后至 CABG 住院后 1 年的所有随访数据，我们根据性别分层，使用对数秩检验评估 IS 的 Kaplan-Meier 累积风险。我们建立 Cox 比例风险模型来计算 IS 再入院的风险比（HR）和 95%置信区间（CI），以性别为主要自变量。我们进行了未调整的模型和调整了年龄、血管风险因素、疾病严重程度和死亡率风险、医院特征以及患者邮政编码收入四分位数的模型。
2013 年，估计有 53270 名女性和 147396 名男性在 CABG 后存活。与男性相比，女性 CABG 后 IS 的累积再入院风险持续升高（对数秩检验 p 值=0.0014）。在未调整的 Cox 模型中，女性与男性的 IS HR 为 1.35（95%CI 1.12-1.62，p=0.0015）。在调整了疾病严重程度（1.30 [1.08-1.56]，p=0.0056）和死亡率风险（1.28 [1.07-1.54]，p=0.0086）后，女性的这种高风险仍然存在。在调整了多种血管风险因素、医院特征和患者邮政编码收入四分位数后，这种高风险仍然存在（1.23 [1.02-1.48]，p=0.03）。
在使用大型、现代、全国性数据库的完全调整模型中，我们发现女性 CABG 后 1 年内 IS 再入院的风险比男性增加了 23%。进一步的研究将阐明女性中这种风险增加的机制。
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