Aboul-Hassan Sleiman Sebastian, Hirnle Grzegorz, Perek Bartlomiej, Jemielity Marek, Kocanda Szymon, Hirnle Tomasz, Brykczynski Miroslaw, Gocol Radoslaw, Deja Marek, Rogowski Jan, Krejca Michal, Pawliszak Wojciech, Widenka Kazimierz, Pacholewicz Jerzy, Bugajski Pawel, Wrobel Krzysztof, Maruszewski Bohdan J, Hrapkowicz Tomasz, Cichon Romuald
Department of Cardiac Surgery, Zbigniew Religa Heart Center "Medinet", Nowa Sol, Poland; Department of Cardiac Surgery and Interventional Cardiology, Faculty of Medicine and Medical Sciences, University of Zielona Gora, Zielona Gora, Poland.
Department of Cardiac Surgery, Transplantology, Vascular and Endovascular Surgery, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland.
Heart Lung Circ. 2025 Jul 1. doi: 10.1016/j.hlc.2025.03.016.
This multicentre study aimed to investigate the impact of deep sternal wound infection (DSWI) on long-term survival among patients undergoing coronary artery bypass grafting (CABG) using multiple arterial grafting (MAG) or single artery with saphenous vein grafts (SAG).
Data were obtained from the Polish National Registry of Cardiac Surgery Procedures database. Between January 2012 and December 2020, 81,136 patients who underwent CABG for multivessel disease were included in the study. Patients were divided into four groups: MAG with DSWI (n=219), MAG without DSWI (n=8,611), SAG with DSWI (n=1,432), and SAG without DSWI (n=70,874). Inverse probability of treatment weighting based on the generalised propensity score was used to minimise imbalance between the groups.
In the weighted sample, DSWI in patients who received MAG was associated with reduced long-term survival when compared with patients without DSWI and MAG (hazard ratio [HR] 1.89, 95% confidence interval [CI] 1.29-2.78; Bonferroni corrected p=0.01). Deep sternal wound infection in patients who received SAG was associated with reduced long-term survival when compared with patients without DSWI and SAG (HR 1.92, 95% CI 1.69-2.17; Bonferroni corrected p=0.01). In patients who did not develop DSWI, MAG was associated with improved long-term survival compared with SAG (HR 0.68, 95% CI 0.63-0.74; Bonferroni corrected p=0.01). However, patients who received MAG and developed DSWI had similar long-term survival when compared with patients who received SAG and did not develop DSWI (HR 1.31, 95% CI 0.90-1.92; Bonferroni corrected p=0.63). A landmark analysis excluding the first 6 months of follow-up was performed to exclude the risk of acute mortality due to DSWI. In the weighted sample, the results were consistent with the main analysis.
Deep sternal wound infection is associated with worse survival in patients receiving MAG and SAG. Moreover, the superior effect of MAG over SAG diminishes once DSWI develops.
本多中心研究旨在调查深部胸骨伤口感染（DSWI）对接受冠状动脉旁路移植术（CABG）的患者长期生存的影响，这些患者使用了多支动脉移植物（MAG）或单支动脉与大隐静脉移植物（SAG）。
数据来自波兰国家心脏手术程序注册数据库。在2012年1月至2020年12月期间，纳入了81136例因多支血管疾病接受CABG的患者。患者分为四组：发生DSWI的MAG组（n = 219）、未发生DSWI的MAG组（n = 8611）、发生DSWI的SAG组（n = 1432）和未发生DSWI的SAG组（n = 70874）。基于广义倾向评分的治疗加权逆概率用于最小化组间不平衡。
在加权样本中，与未发生DSWI且接受MAG的患者相比，接受MAG且发生DSWI的患者长期生存率降低（风险比[HR] 1.89，95%置信区间[CI] 1.29 - 2.78；Bonferroni校正p = 0.01）。与未发生DSWI且接受SAG的患者相比，接受SAG且发生DSWI的患者长期生存率降低（HR 1.92，95% CI 1.69 - 2.17；Bonferroni校正p = 0.01）。在未发生DSWI的患者中，与SAG相比，MAG与更好的长期生存率相关（HR 0.68，95% CI 0.63 - 0.74；Bonferroni校正p = 0.01）。然而，与接受SAG且未发生DSWI的患者相比，接受MAG且发生DSWI的患者长期生存率相似（HR 1.31，95% CI 0.90 - 1.92；Bonferroni校正p = 0.63）。进行了一项排除前6个月随访期的里程碑分析以排除DSWI导致的急性死亡风险。在加权样本中，结果与主要分析一致。
深部胸骨伤口感染与接受MAG和SAG的患者较差的生存率相关。此外，一旦发生DSWI，MAG相对于SAG的优势就会减弱。
