Department of Cardio-Thoracic Surgery Weill Cornell Medicine New York NY USA.
Department of Cardiac Surgery Centre Hospitalier de l'Universite de Montreal Montreal Quebec Canada.
J Am Heart Assoc. 2023 Apr 18;12(8):e028063. doi: 10.1161/JAHA.122.028063. Epub 2023 Apr 7.
Background Limited data exist on long-term readmission and its association with patient and procedural characteristics after coronary artery bypass grafting. We aimed to investigate 5-year readmission after coronary artery bypass grafting and specifically focus on the role of sex and off-pump surgery. Methods and Results We performed a post hoc analysis of the CORONARY (Coronary Artery Bypass Grafting [CABG] Off or On Pump Revascularization) trial, involving 4623 patients. The primary outcome was all-cause readmission, and the secondary outcome was cardiac readmission. Cox models were used to investigate the association of outcomes with sex and off-pump surgery. Hazard function for sex was studied over time using a flexible, fully parametric model, and time-segmented analyses were performed accordingly. Rho coefficient was calculated for the correlation between readmission and long-term mortality. Median follow-up was 4.4 years (interquartile range, 2.9-5.4 years). The cumulative incidence rates of all-cause and cardiac readmission were 29.4% and 8.2% at 5 years, respectively. Off-pump surgery was not associated with either all-cause or cardiac readmission. The hazard for all-cause readmission in women over time was constantly higher than the hazard for men (hazard ratio [HR], 1.21 [95% CI, 1.04-1.40]; =0.011). Time-segmented analyses confirmed the higher risk for all-cause (HR, 1.21 [95% CI, 1.05-1.40]; <0.001) and cardiac (HR, 1.26 [95% CI, 1.03-1.69]; =0.033) readmission in women after the first 3 years of follow-up. All-cause readmission was strongly correlated with long-term all-cause mortality (Rho, 0.60 [95% CI, 0.48-0.66]), whereas cardiac readmission was strongly correlated with long-term cardiovascular mortality (Rho, 0.60 [95% CI, 0.13-0.86]). Conclusions Readmission rates are substantial at 5 years after coronary artery bypass grafting and are higher in women but not with off-pump surgery. Registration URL: http://www.clinicaltrials.gov/; Unique identifier: NCT00463294.
关于冠状动脉旁路移植术后的长期再入院情况及其与患者和手术特点的关系，目前数据有限。我们旨在研究冠状动脉旁路移植术后 5 年的再入院情况，并特别关注性别和非体外循环手术的作用。
我们对 CORONARY（冠状动脉旁路移植术[CABG]体外或非体外循环再灌注）试验进行了事后分析，该试验纳入了 4623 例患者。主要结局是全因再入院，次要结局是心脏再入院。使用 Cox 模型来研究结局与性别和非体外循环手术的关系。使用灵活的完全参数模型研究性别与时间的危险函数，并相应地进行时间分段分析。计算再入院和长期死亡率之间的 Rho 系数。中位随访时间为 4.4 年（四分位距，2.9-5.4 年）。5 年时全因和心脏再入院的累积发生率分别为 29.4%和 8.2%。非体外循环手术与全因或心脏再入院均无关。随着时间的推移，女性全因再入院的风险始终高于男性（危险比[HR]，1.21[95%CI，1.04-1.40]；=0.011）。时间分段分析证实，女性在随访的前 3 年之后，全因（HR，1.21[95%CI，1.05-1.40]；<0.001）和心脏（HR，1.26[95%CI，1.03-1.69]；=0.033）再入院的风险更高。全因再入院与长期全因死亡率密切相关（Rho，0.60[95%CI，0.48-0.66]），而心脏再入院与长期心血管死亡率密切相关（Rho，0.60[95%CI，0.13-0.86]）。
冠状动脉旁路移植术后 5 年的再入院率仍然很高，女性的再入院率更高，但与非体外循环手术无关。
