Department of Cardiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, People's Republic of China.
Braz J Cardiovasc Surg. 2023 Feb 10;38(1):110-123. doi: 10.21470/1678-9741-2021-0301.
According to the American Heart Association guideline for coronary artery bypass grafting (CABG), female patients undergoing on-pump CABG (ONCAB) are at higher risk of short-term adverse outcomes than male patients. However, whether off-pump CABG (OPCAB) can improve the short-term outcome of female patients compared to ONCAB remains unclear.
We conducted a meta-analysis to study the effect of the female sex on short-term outcomes of OPCAB vs. ONCAB. A total of 31,115 patients were enrolled in 12 studies, including 20,245 females who underwent ONCAB and 10,910 females who underwent OPCAB.
The in-hospital mortality in female patients who underwent OPCAB was significantly lower than in those in the ONCAB group with (2.7% vs. 3.4%; odds ratio [OR] 0.76; 95% confidence interval [CI] 0.65-0.89) and without (OR 0.68; 95% CI 0.52-0.89) adjustment for cardiovascular risk factor. The incidence of postoperative stroke in female patients who underwent OPCAB was lower than in those in the ONCAB group (1.2% vs. 2.1%; OR 0.59; 95% CI 0.48-0.73) before cardiovascular risk factor adjustment but was not significant (OR 0.87; 95% CI 0,66-1.16) after adjustment. There was no significant difference in the incidence of postoperative myocardial infarction between women who underwent OPCAB and those in the ONCAB group (1.3% vs. 2.3%; OR 0.88; 95% CI 0.54-1.43).
In contrast to the American Heart Association CABG guideline, female patients who had OPCAB don't have unfavorable outcomes compared with the ONCAB group.
根据美国心脏协会冠状动脉旁路移植术（CABG）指南，与男性患者相比，行体外循环下 CABG（ONCAB）的女性患者短期不良结局风险更高。然而，与 ONCAB 相比，非体外循环下 CABG（OPCAB）是否能改善女性患者的短期结局尚不清楚。
我们进行了一项荟萃分析，以研究女性性别对 OPCAB 与 ONCAB 短期结局的影响。共有 31115 名患者纳入 12 项研究，其中 20245 名女性行 ONCAB，10910 名女性行 OPCAB。
与 ONCAB 组相比，行 OPCAB 的女性患者院内死亡率显著降低（2.7% vs. 3.4%；比值比 [OR] 0.76；95%置信区间 [CI] 0.65-0.89），无论是否对心血管危险因素进行校正。与 ONCAB 组相比，行 OPCAB 的女性患者术后卒中发生率较低（1.2% vs. 2.1%；OR 0.59；95% CI 0.48-0.73），但在调整心血管危险因素后差异无统计学意义（OR 0.87；95% CI 0.66-1.16）。行 OPCAB 的女性患者术后心肌梗死发生率与 ONCAB 组无显著差异（1.3% vs. 2.3%；OR 0.88；95% CI 0.54-1.43）。
与美国心脏协会 CABG 指南相反，行 OPCAB 的女性患者与 ONCAB 组相比结局并无不利。
