Department of Cardiac Surgery, Harefield Hospital, London, UK.
Department of Quality & Safety (Surveillance section), Harefield Hospital, London, UK.
Interact Cardiovasc Thorac Surg. 2022 Jun 1;34(6):958-965. doi: 10.1093/icvts/ivab281.
Female gender and advanced age are regarded as independent risk factors for adverse outcomes after isolated coronary artery bypass grafting (CABG). There is paucity of evidence comparing outcomes of CABG between male and female octogenarians. We aimed to analyse in-hospital outcomes of isolated CABG in this cohort.
All octogenarians that underwent isolated CABG, from January 2000 to October 2017, were included. A retrospective analysis of a prospectively collected cardiac surgery database (PATS; Dendrite Clinical Systems, Oxford, UK) was performed. A propensity score was generated for each patient from a multivariable logistic regression model based on 25 pre-treatment covariates. A total of 156 matching pairs were derived.
Five hundred and sixty-seven octogenarians underwent isolated CABG. This included 156 females (mean age 82.1 [SD: 0.9]) and 411 males (mean age 82.4 [SD: 2.1 years]). More males were current smokers (P = 0.002) with renal impairment (P = 0.041), chronic obstructive pulmonary disease (P = 0.048), history of cerebrovascular accident (P = 0.039) and peripheral vascular disease (P = 0.027) while more females had New York Heart Association class 4 (P = 0.02), left ventricular ejection fraction 30-49% (P = 0.038) and left ventricular ejection fraction <30% (P = 0.049). On-pump, CABG was performed in 140 males and 52 females (P = 0.921). There was no difference in in-hospital mortality (5.4% vs 6.4%; P = 0.840), stroke (0.9% vs 1.3%; P = 0.689), need for renal replacement therapy (17.0% vs 13.5%; P = 0.732), pulmonary complications (9.5% vs 8.3%; P = 0.746) and sternal wound infection (2.7% vs 2.6%; P = 0.882). The outcomes were comparable for the propensity-matched cohorts.
No gender difference in outcomes was seen in octogenarians undergoing isolated CABG.
女性和高龄被认为是单纯冠状动脉旁路移植术（CABG）后不良结局的独立危险因素。关于 80 岁以上男性和女性行 CABG 术后结局的比较研究证据较少。本研究旨在分析该队列中单纯 CABG 的院内结局。
纳入 2000 年 1 月至 2017 年 10 月期间行单纯 CABG 的所有 80 岁以上患者。对前瞻性收集的心脏手术数据库（PATS；Dendrite Clinical Systems，牛津，英国）进行回顾性分析。使用多变量逻辑回归模型，基于 25 个术前变量，为每位患者生成一个倾向评分。共得出 156 对匹配组。
567 例 80 岁以上患者行单纯 CABG。其中 156 例女性（平均年龄 82.1 [标准差：0.9] 岁）和 411 例男性（平均年龄 82.4 [标准差：2.1 岁]）。更多男性为当前吸烟者（P=0.002），伴有肾功能不全（P=0.041）、慢性阻塞性肺疾病（P=0.048）、脑血管意外史（P=0.039）和外周血管疾病（P=0.027），而更多女性患有纽约心脏协会（NYHA）心功能分级 4 级（P=0.02）、左心室射血分数 30%-49%（P=0.038）和左心室射血分数<30%（P=0.049）。140 例男性和 52 例女性接受了体外循环下 CABG（P=0.921）。院内死亡率（5.4% vs 6.4%；P=0.840）、卒中（0.9% vs 1.3%；P=0.689）、需要肾脏替代治疗（17.0% vs 13.5%；P=0.732）、肺部并发症（9.5% vs 8.3%；P=0.746）和胸骨伤口感染（2.7% vs 2.6%；P=0.882）方面无差异。倾向评分匹配队列的结果相似。
80 岁以上单纯 CABG 患者的结局无性别差异。
