Impact of Gender on Arterial Revascularization Strategies for Coronary Artery Bypass Grafting
Impact of Gender on Arterial Revascularization Strategies for Coronary Artery Bypass Grafting
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DOI：
10.1016/j.athoracsur.2017.06.054
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发表时间：
2018-01-01
影响因子：
4.6
通讯作者：
Rubens, Fraser D.
中科院分区：
文献类型：
--
作者：
Jabagi, Habib;Tran, Diem T.;Rubens, Fraser D.
背景资料。冠状动脉手术中的动脉血运重建方法存在显著的性别差异。这项研究解决了这些差异，以确定差异是否与潜在的风险特征或系统性的性别偏见有关。对19557例接受单纯冠状动脉旁路移植术(CABG)的患者进行了血运重建方法的性别特异性改变。根据45个治疗前协变量，在1,254名CABG患者的子集上生成倾向平衡组，以评估匹配组(每组627名患者)的发生率。在整个队列中，男性与双侧胸内动脉使用量的增加相关(优势比，1.667；95%可信区间[CI]，1.166至2.386；p=0.005)。在男性和女性中，多动脉移植的使用率每年都在增加，但男性BITA使用率的增加幅度更大(1.59%/年[95%CI，1.56~1.63]vs 1.37%/年[95%CI，1.3~1.45]，p<；0.001)，3支动脉的使用率(1.16%/年[95%CI，1.13~1.2]vs 0.73%/年[95%CI，0.67~0.8]，p<；0.001)和使用任意两条动脉(2.34%/年(95%可信区间，2.32~2.35)vs 1.92%/年[95%可信区间，1.9~1.95]，p<；0.001)。在倾向匹配组中，BITA的使用(男性：31.9%，女性：30.1%；p=0.502)、低风险患者使用BITA(男性：46.4%，女性：38.0%；p=0.126)和桡动脉使用(男性：44.5%，女性：44.1%；p[0.994)，但男性更多地使用3条动脉(10.5%vs7.3%，p=0.048)。与男性相比，女性接受的完全多动脉冠状动脉血运重建术较少。这可能与共病情况较高的女性较晚出现冠状动脉疾病有关；然而，当匹配时，可能仍然存在偏见，限制了女性接受3支动脉移植的选择。(C)2018年，由胸外科医生学会主办
Background. There are significant gender differences in arterial revascularization approaches in coronary operations. This study addressed these differences to determine whether discrepancies are related to underlying risk profiles or systematic gender bias.Methods. Changes in gender-specific rates of revascularization approaches were determined in 19,557 patients undergoing isolated coronary artery bypass grafting (CABG). A propensity-balanced group was generated on a subset of 1,254 CABG patients based on 45 pretreatment covariates to assess rates in matched groups (627 patients per group).Results. In the entire cohort, male gender was associated with increased bilateral internal thoracic artery (BITA) use (odds ratio, 1.667; 95% confidence interval [CI], 1.166 to 2.386; p = 0.005). Multiple-arterial grafting increased yearly in both genders, but the rate of increase in BITA use was greater in men (1.59%/year [95% CI, 1.56 to 1.63] vs 1.37%/year [95% CI, 1.30 to 1.45], p < 0.001) as was the use of 3 arteries (1.16%/year [95% CI, 1.13 to 1.20] vs 0.73%/year [95% CI, 0.67 to 0.80), p < 0.001) and the use of any 2 arteries (2.34%/year (95% CI, 2.32 to 2.35) vs 1.92%/year [95% CI, 1.90 to 1.95], p < 0.001). In the propensity-matched group, there was no difference in BITA use (male: 31.9%, female: 30.1%; p = 0.502), BITA use in low-risk patients (male: 46.4%, female: 38.0%; p = 0.126), or radial artery use (male: 44.5%, female: 44.1%; p[0.994), but use of 3 arteries was greater in men (10.5% vs 7.3%, p = 0.048).Conclusions. Women receive less complete multiple arterial coronary revascularization than men. This is likely related to later presentation of coronary artery disease in women with higher comorbidity profiles; however, when matched, bias may still exist limiting the option of grafting with 3 arteries to women. (C) 2018 by The Society of Thoracic Surgeons