Postgraduate Program in Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
PLoS One. 2024 Sep 6;19(9):e0306902. doi: 10.1371/journal.pone.0306902. eCollection 2024.
There are controversies regarding the impact of sex on mortality and postoperative complications in patients undergoing on-pump coronary artery bypass grafting (CABG), although some studies demonstrate comparable outcomes. This study sought to evaluate sex differences regarding risk factors associated with hospital mortality and postoperative clinical outcomes among patients undergoing isolated on-pump CABG. We conducted a retrospective observational cohort study of patients who underwent isolated on-pump CABG from January 1996 to January 2020. Patients were divided into two groups (male and female) and compared regarding preoperative characteristics, surgical technical variables, and in-hospital outcomes. All-cause mortality between groups was compared using logistic regression. Risk factors for mortality, along with their respective odds ratios (OR), were separately assessed using a logistic regression model with p-values for interaction. We analyzed 4,882 patients, of whom 31.6% were female. Women exhibited a higher prevalence of age >75 years (12.2% vs 8.3%, p<0.001), obesity (22.6% vs 11.5%, p<0.001), diabetes (41.6% vs 32.2%, p<0.001), hypertension (85.2% vs 73.5%, p<0.001), and NYHA functional classes 3 and 4 (16.2% vs 11.2%, p<0.001) compared to men. Use of the mammary artery for revascularization was less frequent among women (73.8% vs 79.9%, p<0.001), who also received fewer saphenous vein grafts (2.17 vs 2.27, p = 0.002). A history of previous or recent myocardial infarction (MI) had an impact on women's mortality, unlike in men (OR 1.61 vs 0.94, p = 0.014; OR 1.86 vs 0.99, p = 0.015, respectively). After adjusting for several risk factors, mortality was found to be comparable between men and women, with an OR of 1.20 (95% CI 0.94-1.53, p = 0.129). In conclusion, female patients undergoing isolated on-pump CABG presented with a higher number of comorbidities. Previous and recent MI were associated with higher mortality only in women. In this cohort analysis, female gender was not identified as an independent risk factor for outcome after CABG.
关于性别对行体外循环冠状动脉旁路移植术（CABG）患者死亡率和术后并发症的影响存在争议，尽管一些研究表明其结果相似。本研究旨在评估在接受单纯体外循环 CABG 的患者中，与医院死亡率和术后临床结局相关的风险因素是否存在性别差异。我们对 1996 年 1 月至 2020 年 1 月期间接受单纯体外循环 CABG 的患者进行了回顾性观察性队列研究。患者分为两组（男性和女性），比较术前特征、手术技术变量和住院结局。使用逻辑回归比较两组间全因死亡率。使用逻辑回归模型分别评估死亡率的危险因素及其相应的比值比（OR），并对交互作用的 p 值进行评估。我们分析了 4882 例患者，其中 31.6%为女性。女性中年龄>75 岁（12.2%比 8.3%，p<0.001）、肥胖（22.6%比 11.5%，p<0.001）、糖尿病（41.6%比 32.2%，p<0.001）、高血压（85.2%比 73.5%，p<0.001）和 NYHA 功能分级 3 和 4 级（16.2%比 11.2%，p<0.001）的比例高于男性。女性使用乳内动脉进行血运重建的比例较低（73.8%比 79.9%，p<0.001），且接受的大隐静脉移植物也较少（2.17 比 2.27，p=0.002）。与男性不同，既往或近期心肌梗死（MI）病史对女性的死亡率有影响（OR 1.61 比 0.94，p=0.014；OR 1.86 比 0.99，p=0.015）。在校正了多个危险因素后，男性和女性的死亡率相当，OR 为 1.20（95%CI 0.94-1.53，p=0.129）。总之，接受单纯体外循环 CABG 的女性患者合并症更多。既往和近期 MI 仅与女性死亡率升高相关。在本队列分析中，女性性别并非 CABG 后结局的独立危险因素。
