Pölzl Leo, Thielmann Matthias, Sterzinger Philipp, Nägele Felix, Hirsch Jakob, Graber Michael, Engler Clemens, Eder Jonas, Lohmann Ronja, Schmidt Sophia, Staggl Simon, Heuts Samuel, Ulmer Hanno, Grimm Michael, Ruttmann-Ulmer Elfriede, Bonaros Nikolaos, Holfeld Johannes, Gollmann-Tepeköylü Can
Department of Cardiac Surgery, Medical University of Innsbruck, Austria.
Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany.
Ann Thorac Surg. 2025 Jan;119(1):120-128. doi: 10.1016/j.athoracsur.2024.06.019. Epub 2024 Jul 2.
The impact of sex-differences on the release of cardiac biomarkers after coronary artery bypass grafting (CABG) remains unknown. The aim of our study was to (1) investigate the impact of sex-differences in cardiac biomarker release after CABG and (2) determine sex-specific thresholds for high-sensitivity cardiac troponin (hs-cTn) and creatine kinase-myocardial band (CK-MB) associated with 30-day major adverse cardiovascular events (MACE) and mortality.
A consecutive cohort of 3687 patients, comprising 643 women (17.4%) and 3044 men (82.6%), undergoing CABG from 2008 to 2021 in 2 tertiary university centers with serial postoperative cTn and CK-MB measurement was analyzed. The composite primary outcome was MACE at 30 days. Secondary end points were 30-day mortality and 5-year mortality and MACE. Sex-specific thresholds for cTn and CK-MB were determined.
Lower levels of cTn were found in women after CABG (69.18 vs 77.57 times the upper reference limit [URL]; P < .001). The optimal threshold value for cTn was calculated at 94.36 times the URL for female patients and 206.07 times the URL for male patients to predict 30-day MACE. Female patients missed by a general threshold had increased risk for MACE or death within 30 days (cTn: MACE: odds ratio [OR], 3.78; 95% CI, 1.03-13.08; P = .035; death: OR, 4.98; 95% CI, 1.20-20.61; P = .027; CK-MB: MACE: OR, 10.04; 95% CI, 2.07-48.75; P < .001; death: OR 13.59; 95% CI, 2.66-69.47; P = .002).
We provide evidence for sex-specific differences in the outcome and biomarker release after CABG. Sex-specific cutoffs are necessary for the diagnosis of perioperative myocardial injury to improve outcomes of women after CABG.
性别差异对冠状动脉旁路移植术（CABG）后心脏生物标志物释放的影响尚不清楚。我们研究的目的是：（1）调查CABG后心脏生物标志物释放中的性别差异影响；（2）确定与30天主要不良心血管事件（MACE）和死亡率相关的高敏心肌肌钙蛋白（hs-cTn）和肌酸激酶同工酶（CK-MB）的性别特异性阈值。
分析了2008年至2021年在2个三级大学中心接受CABG的3687例连续队列患者，其中包括643名女性（17.4%）和3044名男性（82.6%），术后连续测量cTn和CK-MB。复合主要结局是30天时的MACE。次要终点是30天死亡率、5年死亡率和MACE。确定了cTn和CK-MB的性别特异性阈值。
CABG后女性的cTn水平较低（69.18对比77.57倍高于参考上限[URL]；P <.001）。计算出女性患者预测30天MACE的cTn最佳阈值为94.36倍URL，男性患者为206.07倍URL。被一般阈值遗漏的女性患者在30天内发生MACE或死亡的风险增加（cTn：MACE：比值比[OR]，3.78；95%CI，1.03-13.08；P =.035；死亡：OR，4.98；95%CI，1.20-20.61；P =.027；CK-MB：MACE：OR，10.04；95%CI，2.07-48.75；P <.001；死亡：OR 13.59；95%CI，2.66-69.47；P =.002）。
我们提供了CABG后结局和生物标志物释放中性别特异性差异的证据。围手术期心肌损伤的诊断需要性别特异性临界值，以改善CABG后女性的结局。
