Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
J Thorac Cardiovasc Surg. 2024 May;167(5):1796-1807.e15. doi: 10.1016/j.jtcvs.2023.02.008. Epub 2023 Feb 15.
Multiple arterial grafting (MAG) and off-pump surgery are strategies proposed to improve outcomes with coronary artery bypass grafting (CABG). This study was conducted to determine the impact of off-pump surgery on outcomes after CABG with MAG in men and women.
This cohort study used population-based data to identify all Ontarians undergoing isolated CABG with MAG between October 2008 and September 2019. The primary outcome was all-cause mortality. Secondary outcomes included major adverse cardiac and cerebrovascular events (MACCE; hospitalization for stroke, myocardial infarction hospitalization or heart failure, or repeat revascularization). Analysis used propensity-score overlap-weighted cause-specific Cox proportional hazard regression.
A total of 2989 women (1188 off-pump, 1801 on-pump) and 16,209 men (6065 off-pump, 10,144 on-pump) underwent MAG with a median follow-up of 5.0 years (interquartile range, 2.7-8.0) years. Compared to the on-pump approach, all-cause mortality was not changed with off-pump status (hazard ratio [HR] in women: 1.25 [95% CI, 0.83-1.88]; in men: 1.08 [95% CI, 0.85-1.37]). In women, the risk of MACCE was significantly higher off-pump (HR, 1.45; 95% CI, 1.04-2.03), with nonsignificantly increased risk observed for all component outcomes.
In patients undergoing CABG with MAG, this population-based analysis found no association between pump status and survival in either men or women. However, it did suggest that off-pump MAG in women may be associated with an increased risk of MACCE.
多动脉搭桥术（MAG）和非体外循环手术是被提出用于改善冠状动脉旁路移植术（CABG）结果的策略。本研究旨在确定非体外循环手术对 MAG 下 CABG 男性和女性患者结局的影响。
本队列研究使用基于人群的数据，确定 2008 年 10 月至 2019 年 9 月期间所有接受 MAG 下孤立性 CABG 的安大略省居民。主要结局为全因死亡率。次要结局包括主要心脏和脑血管不良事件（MACCE；中风住院、心肌梗死住院或心力衰竭住院或再次血运重建）。分析采用倾向评分重叠加权特定原因 Cox 比例风险回归。
共纳入 2989 名女性（1188 名非体外循环，1801 名体外循环）和 16209 名男性（6065 名非体外循环，10144 名体外循环），中位随访时间为 5.0 年（四分位距，2.7-8.0）。与体外循环方法相比，非体外循环状态下全因死亡率没有变化（女性：1.25[95%CI，0.83-1.88]；男性：1.08[95%CI，0.85-1.37]）。在女性中，非体外循环的 MACCE 风险显著更高（HR，1.45；95%CI，1.04-2.03），所有组成部分结局的风险也有增加但无统计学意义。
在接受 MAG 下 CABG 的患者中，这项基于人群的分析在男性和女性中均未发现泵状态与生存之间存在关联。然而，它确实表明女性的非体外循环 MAG 可能与 MACCE 风险增加相关。
