Norton Elizabeth L, Binongo Jose N, Dassanayake Maya, Ou Changrui, Wei Jane W, Halkos Michael E, Wenger Nanette K, Ward Alison F
Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia.
Ann Thorac Surg Short Rep. 2023 Aug 19;1(4):626-630. doi: 10.1016/j.atssr.2023.07.015. eCollection 2023 Dec.
Studies have shown that women have worse outcomes after coronary artery bypass grafting (CABG); it is unclear whether this knowledge has led to improved outcomes over time. This study sought to examine temporal trends in women undergoing CABG.
From 2000 to 2021, 9062 women underwent isolated CABG at a single institution. The institutional Society of Thoracic Surgeons database was queried for preoperative, intraoperative, and postoperative variables. The cohort was stratified by date of operation into 6 groups coinciding with versions of The Society of Thoracic Surgeons database: 2002-2004/version 2.41 (n = 1348 [15%]), 2004-2007/version 2.52 (n = 2413 [27%]), 2008-2011/version 2.61 (n = 2244 [25%]), 2011-2014/version 2.73 (n = 1230 [14%]), 2014-2017/version 2.81 (n = 783 [9%]), and 2017-2021/version 2.9 (n = 1044 [12%]).
The median age was 66 (interquartile range, 58-74) years. Comorbid conditions including chronic lung disease, cerebrovascular disease, diabetes, hypertension, and heart failure increased over time. The number of urgent CABG procedures increased from 20% in the 2002-2004 group to 66% in the 2017-2021 group, whereas the number of elective CABG procedures decreased from 76% to 32% ( < .001). From 2002-2004 to 2017-2021, internal mammary artery use increased from 85% to 92% ( < .001). Mortality did not improve for women over time, in-hospital mortality was significantly higher for women (3.6%) than for men (1.8%; < .001), and the gap between women and men remained unchanged over time.
Mortality of women undergoing CABG at our institution (3.6%) remains higher than the overall national average (∼2%) and that of the male institutional cohort (1.8%). Further studies to understand this disparity and to improve care for women undergoing CABG are needed.
研究表明，女性在冠状动脉旁路移植术（CABG）后预后较差；目前尚不清楚随着时间推移，这一认知是否带来了预后改善。本研究旨在探讨接受CABG的女性患者的时间趋势。
2000年至2021年期间，9062名女性在单一机构接受了单纯CABG手术。查询该机构胸外科医师协会数据库中的术前、术中和术后变量。根据手术日期将队列分为6组，与胸外科医师协会数据库的版本相对应：2002 - 2004年/版本2.41（n = 1348 [15%]），2004 - 2007年/版本2.52（n = 2413 [27%]），2008 - 2011年/版本2.61（n = 2244 [25%]），2011 - 2014年/版本2.73（n = 1230 [14%]），2014 - 2017年/版本2.81（n = 783 [9%]），以及2017 - 2021年/版本2.9（n = 1044 [12%]）。
中位年龄为66岁（四分位间距，58 - 74岁）。包括慢性肺病、脑血管疾病、糖尿病、高血压和心力衰竭在内的合并症随时间增加。急诊CABG手术数量从2002 - 2004年组的20%增加到2017 - 2021年组的66%，而择期CABG手术数量从76%降至32%（P < .001）。从2002 - 2004年到2017 - 2021年，乳内动脉使用率从85%增加到92%（P < .001）。随着时间推移，女性的死亡率并未改善，女性的住院死亡率（3.6%）显著高于男性（1.8%；P < .001），且男女之间的差距随时间保持不变。
在我们机构接受CABG的女性患者死亡率（3.6%）仍高于全国总体平均水平（约2%）以及男性机构队列的死亡率（1.8%）。需要进一步研究以了解这种差异并改善接受CABG的女性患者的护理。
