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在同时进行冠状动脉旁路移植和大动脉置换手术后,男性和女性的差异不同

Rebecca Krey¹, Moritz Jakob^1,2, Matthias Karck¹

¹Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany.

ESC heart failure

|May 26, 2024

概括

接受冠状动脉旁路移植和大动脉置换手术的女性患者面临更高的死亡率. 这种差异在七十岁以上的人群中尤为明显,突出了潜在的基于性别的风险和治疗差异.

科学领域:

心血管外科心血管外科
心脏外科手术的结果
基于性别的医学

背景情况:

结合冠状动脉旁路移植 (CABG) 和大动脉置换 (AVR) 携带显著的外科手术风险.
临床风险评分往往表明CABG和AVR联合的死亡率增加,特别是在女性患者中.
了解基于性别的结果差异对于优化患者护理至关重要.

研究的目的:

调查CABG和AVR组合后短期结果的基于性别的差异.
根据年龄组对结果进行分层,以确定特定的风险因素.
分析术前特征和手术因素对死亡率和重大不良事件的影响.

主要方法:

在2001年至2021年期间,对1963名接受CABG和AVR联合治疗的患者进行了回顾性分析.
患者被分为四个年龄组:≤59,60-69,70-79和≥80岁.
主要终点包括30天和180天死亡率;次要终点评估风险因素,性别影响和主要不良事件.

主要成果:

女性患者的30天和180天死亡率显著更高 (分别为8.3%与4.2%和15.8%与9.4%).
在70-79岁年龄组 (七十岁) 的女性中,死亡率仍然明显较高.
女性性别,晚年,糖尿病和较低的射出分数 (<30%) 与增加的死亡率相关;不经常使用内部乳腺动脉移植与更糟糕的结果有关.

结论:

基线特征的性别差异可能导致女性患者的手术干预延迟.
固有的风险概况和潜在的不那么激进的手术策略 (例如,较少的内部乳腺动脉移植) 可能解释结果的差异,特别是在老年女性患者中.
需要进一步的研究来解决影响CABG和AVR结合后结果的性别特异性因素.

关键词:

大动脉门的更换冠状动脉复血管化治疗不平等的差异差异的差异男女之间的差异.死亡率死亡率死亡率结果结果的结果.

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