Clinical Study On Prognosis And Risk Factors Of Coronary Artery Bypass Grafting In Patients With Different Gender

BackgroundCoronary atherosclerotic heart disease is a common cardiovascular disease that seriously threatens human health.The prevalence of multi-vessel coronary artery disease is relatively high,accounting for 41%～67%of patients with coronary artery stenosis.Coronary artery bypass grafting has become an important surgical method for the treatment of coronary heart disease,especially the severe lesions of the left main coronary artery and the multi-vessel coronary artery.It restores the blood flow of the distal coronary artery and cures the stenosis through myocardial revascularization,thereby improving myocardial blood supply.Preventing the occurrence of angina pectoris or myocardial infarction in patients can improve the survival quality of patients and reduce mortality.At least 50%of CHD patients in the United States have received coronary artery bypass grafting.At present,the number of patients receiving coronary artery bypass grafting is gradually increasing in China.Based on inherent gender differences,male and female have different risks for coronary artery bypass grafting.A study conducted by Kennedy et al.in 1980 found for the first time that females had a poorer prognosis after coronary artery bypass grafting.However,based on the current domestic and foreign literature reports,there is still a lack of research on gender factors in patients undergoing coronary artery bypass grafting.An adequate assessment of this gender difference before surgery and the prediction of risk factors between male and female patients are important to improve the survival rate of patients undergoing coronary artery bypass grafting.ObjectiveTo retrospectively study the clinic data of patients undergoing coronary artery bypass grafting,we analyzed and discussed the gender differences of the preoperative profiles,postoperative complications,early mortality,and long-term prognosis in males and females undergoing coronary artery bypass grafting,predicting risk factors for early and long-term postoperative mortality in them.In addition,we summarized the treatment experience of coronary artery bypass grafting in our center and provided an objective reference basis for the implementation of individualized diagnosis and treatment.Our experience could help to promote the smooth operation of patients’rehabilitation and improve the long-term survival rate.MethodsWe selected 400 patients who underwent off-pump coronary artery bypass graft surgery from December 2014 to December 2019 in the First Affiliated Hospital of Zhengzhou University,including 282 males(70.5%)and 118 females(29.5%).The clinical data of the two groups of patients pre-,during,and post-operative were included in this study.Many factors were including:(1)baseline characteristics,including age,height,weight,BMI,comorbidities(hypertension,diabetes,hyperlipidemia,old myocardial infarction,previous PCI,COPD,atrial fibrillation,stroke,peripheral vascular disease),emergency surgery,EuroSCORE,LVEF,preoperative hemoglobin and creatinine,coronary vascular disease;(2)surgical indicators,including operation time,number of grafts,and the proportion of internal mammary artery used;(3)postoperative hospitalization,including two groups of ventilator assistance time,intensive care unit stay time,hospital stay;(4)postoperative complications(low cardiac output syndrome;IABP support;respiratory failure;renal failure;stroke;recurrent myocardial infarction;new-onset atrial fibrillation;exploratory thoracotomy due to hemorrhage;incision infection;blood product transfusion ratio)and early mortality;(5)survival rate during follow-up of the two groups and readmission rate.ResultsAs shown in univariate analysis and multivariate logistic regression analysis,patient’s age,preoperative blood creatinine levels were identified as predictors of early death after CABG in both sexes,and preoperative hemoglobin and LVEF were protective factors for both sexes.COPD had only been identified as an independent risk factor for early death in males,while diabetes was only significant in females and was an independent risk factor for early death in the female patients.The 1-year and 5-year readmission rates were 15%and 35%,respectively,in female patients and 10%and 25%,respectively,in male patients.The 1-year and 5-year survival rates of female patients were 83.1%and 72.1%,respectively,and those of male patients were 91.8%and 75.2%,respectively.Univariate analysis and Cox Proportional-Hazards Model showed that diabetes was a risk factor for long-term mortality in both sexes,while COPD was only a risk factor for long-term mortality in male patients,and more than 2 episodes of atrial fibrillation during postoperative hospitalization and the preoperative creatinine level were risk factors for the long-term mortality of female patients.Conclusions1.Patient age and preoperative serum creatinine are identified as common risk factors for early mortality after CABG in both male and female patients,while preoperative hemoglobin level and LVEF were protective factors for early mortality after CABG in both patients.2.Diabetes is an independent risk factor for early mortality in female patients and a risk factor for long-term mortality in both sexes.COPD is a risk factor for early and long-term mortality in male patients.More than 2 episodes of atrial fibrillation during postoperative hospitalization and the preoperative prior myocardial infarction are risk factors for the long-term mortality of female patients.