冠状动脉旁路移植术技术的性别差异：胸外科医师学会数据库分析。
Sex Differences in Coronary Artery Bypass Grafting Techniques: A Society of Thoracic Surgeons Database Analysis.
机构信息
Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Medicine, Baltimore, Maryland.
出版信息
Ann Thorac Surg. 2022 Jun;113(6):1979-1988. doi: 10.1016/j.athoracsur.2021.06.039. Epub 2021 Jul 16.
BACKGROUND
Female patients with coronary artery disease have inferior outcomes compared with male patients, including higher mortality after coronary artery bypass graft surgery (CABG). We aimed to evaluate the association of female sex with the use of guideline-concordant CABG revascularization techniques.
METHODS
The Society of Thoracic Surgeons Adult Cardiac Surgery Database was queried for adult patients who underwent first-time isolated CABG in the United States from 2011 to 2019. The association between female sex and the odds of (1) receiving a left internal mammary artery graft for revascularization of the left anterior descending artery, (2) undergoing complete revascularization, and (3) undergoing multiarterial grafting was assessed, adjusting for procedural anatomy.
RESULTS
Among 1,212,487 patients meeting inclusion criteria, 75% were male (n = 911,178) and 25% were female (n = 301,309). Female sex was associated with lower unadjusted rates of revascularization with an internal mammary artery graft (93.9% vs 95.9%, P < .001), bilateral internal mammary artery graft (2.9% vs 5.6%, P < .001), or radial artery graft (3.2% vs 5.6%, P < .001). After adjustment, female patients had lower odds than males of receiving a left internal mammary artery graft to the left anterior descending artery (adjusted odds ratio 0.79; 95% confidence interval, 0.75 to 0.83; P < .001), undergoing complete revascularization (adjusted odds ratio 0.86; 95% confidence interval, 0.83 to 0.90; P < .001), and undergoing multiarterial grafting (adjusted odds ratio 0.78; 95% confidence interval, 0.75 to 0.81; P < .001).
CONCLUSIONS
Female sex was associated with 14% to 22% lower odds of undergoing guideline-concordant revascularization including left internal mammary artery to left anterior descending artery grafting, multiarterial grafting, and complete revascularization. Further investigation is necessary to determine why revascularization approaches differ by sex and to what degree sex disparities in coronary artery disease outcomes are due to surgical approach.
背景
与男性患者相比，患有冠状动脉疾病的女性患者的预后较差，包括冠状动脉旁路移植术（CABG）后的死亡率更高。我们旨在评估女性性别与指南一致的 CABG 血运重建技术的使用之间的关联。
方法
从 2011 年至 2019 年，在美国对接受首次单独 CABG 的成年患者进行了胸外科医生协会成人心脏手术数据库查询。评估了女性性别与以下可能性之间的关联：（1）接受左内乳动脉移植物进行前降支的血运重建；（2）进行完全血运重建；（3）进行多动脉搭桥。调整了手术解剖学的影响。
结果
在符合纳入标准的 1,212,487 名患者中，75%为男性（n=911,178），25%为女性（n=301,309）。女性性别与未经调整的内乳动脉血管重建率较低相关，包括左内乳动脉（93.9% vs 95.9%，P<0.001），双侧内乳动脉（2.9% vs 5.6%，P<0.001）或桡动脉移植物（3.2% vs 5.6%，P<0.001）。调整后，女性患者接受左内乳动脉到前降支血管重建的可能性低于男性（调整后的优势比为 0.79；95%置信区间为 0.75 至 0.83；P<0.001），进行完全血运重建（调整后的优势比为 0.86；95%置信区间为 0.83 至 0.90；P<0.001），并进行多动脉搭桥（调整后的优势比为 0.78；95%置信区间为 0.75 至 0.81；P<0.001）。
结论
女性性别与接受指南一致的血运重建的可能性降低 14%至 22%相关，包括左内乳动脉到前降支的血管重建，多动脉搭桥和完全血运重建。需要进一步调查以确定为什么性别会导致血运重建方法不同，以及冠状动脉疾病结果的性别差异在多大程度上归因于手术方法。
Zotero 插件