Akram Riswan, Sobik Friedrich, Knochenhauer Tim, Philipp Sebastian A, Brickwedel Jens, Hua Xiaoqin, Reiter Beate, Zipfel Svante, Schneeberger Yvonne, Girdauskas Evaldas, Reichenspurner Hermann, Sill Bjoern, Schaefer Andreas
Department of Cardiology, Elbe Clinic Stade, Stade, Germany.
Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
Front Cardiovasc Med. 2025 Aug 1;12:1641784. doi: 10.3389/fcvm.2025.1641784. eCollection 2025.
Surgical myocardial revascularization shows impaired outcomes in women compared to men. Investigation of gender related outcome differences comprises of different operative strategies potentially hampering interpretation of data. We herein aimed to investigate gender related outcome differences in off-pump coronary artery bypass grafting (OPCAB) only.
Between 2016 and 2021, 1,075 consecutive patients underwent OPCAB at our center. Of those 880/1,075 were male (81.9%) and 195/1,075 were female (18.1%). Kaplan-Meier analysis was used for investigating differences in survival probabilities. Identification of risk factors was conducted by logistic regression.
Male patients showed a higher rate of reduced LVEF < 35% (88/880, 10% vs. 9/195, 4.61%; = 0.025) and impaired renal function (creatinine: 1.17 ± 0.76 vs. 1.03 ± 0.59; = 0.016). In female patients less utilization of both internal mammary arteries was documented (502/880, 57.04% vs. 74/195, 37.94%; < 0.001). Procedure time (256.13 min vs. 238.02 min; < 0.001) and number of distal anastomoses (2.40 ± 0.83 vs. 2.11 ± 0.82; < 0.001) were lower in female patients. 30-day mortality (16/880, 0.34% vs. 4/195, 0.51%; = 0.77) and rates of disabling stroke (3/880, 1.81% vs. 1/195, 2.05%; = 0.55) were similar between groups. In logistic regression analysis age (OR 1.079; CI 1.001- 1.162; = 0.047) and impaired renal function (OR 1.495; CI 1.090-2.051; = 0.013) were identified as independent risk factors for 30-day mortality.
Male and female patients present similar 30-day outcomes after OPCAB suggesting a potential benefit of OPCAB in female patients. However, female patients receive more saphenous vein grafts compared to men, which may lead to impaired long-term outcomes.
与男性相比，外科心肌血运重建术在女性中的预后较差。对性别相关预后差异的研究包括不同的手术策略，这可能会妨碍对数据的解读。我们在此旨在仅研究非体外循环冠状动脉旁路移植术（OPCAB）中性别相关的预后差异。
2016年至2021年期间，我们中心连续有1075例患者接受了OPCAB手术。其中880/1075为男性（81.9%），195/1075为女性（18.1%）。采用Kaplan-Meier分析来研究生存概率的差异。通过逻辑回归进行危险因素的识别。
男性患者左心室射血分数降低至<35%的比例更高（88/880，10% 对 9/195，4.61%；P = 0.025）且肾功能受损（肌酐：1.17±0.76对1.03±0.59；P = 0.016）。在女性患者中，双侧乳内动脉的使用率较低（502/880，57.04%对74/195，37.94%；P<0.001）。女性患者的手术时间（256.13分钟对238.02分钟；P<0.001）和远端吻合口数量（2.40±0.83对2.11±0.82；P<0.001）更低。两组间30天死亡率（16/880，0.34%对4/195，0.51%；P = 0.77）和致残性卒中发生率（3/880，1.81%对1/195，2.05%；P = 0.55）相似。在逻辑回归分析中，年龄（OR 1.079；CI 1.001 - 1.162；P = 0.047）和肾功能受损（OR 1.495；CI 1.090 - 2.051；P = 0.013）被确定为30天死亡率的独立危险因素。
OPCAB术后男性和女性患者的30天预后相似，提示OPCAB对女性患者可能有益。然而，与男性相比，女性患者接受的大隐静脉移植更多，这可能导致长期预后受损。
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