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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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Survival After Bilateral Internal Mammary Artery in Coronary Artery Bypass Grafting: Are Women at Risk?
Session:
Posters 1 - Écran 04 - Cirurgia Cardíaca
Speaker:
Rui j. Cerqueira
Congress:
CPC 2018
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
26. Cardiovascular Surgery
Subtheme:
26.1 Cardiovascular Surgery – Coronary Arteries
Session Type:
Posters
FP Number:
---
Authors:
Rui Cerqueira; Francisca Saraiva; Nicolas Girerd; João P. Ferreira; Noélia Vilas-Boas; Paulo Pinho; Antonio S. Barros; Mário Jorge Amorim; André Lourenço; Adelino Leite-Moreira
Abstract
<p><strong>Background:</strong> Most observational studies support long-term survival benefit after bilateral internal mammary artery (BIMA) compared with single internal mammary artery (SIMA) coronary artery bypass grafting (CABG) but data on females is scarce. We compared survival and safety of BIMA <em>versus</em> SIMA CABG between males and females at our tertiary care center.</p> <p><strong>Methods:</strong> Single-center retrospective cohort including consecutive patients with stenosis in at least 2 left-coronary vessels who underwent isolated CABG with at least 1 internal mammary artery and a minimum of 2 conduits targeting the left-coronary territory in 2004-2013. All-cause mortality was the primary outcome, secondary outcomes were in-hospital mortality and reoperation due to sternal wound complications (SWC). Kaplan-Meier analysis after inverse probability weighting using propensity score (IPW) was used to compare BIMA and SIMA CABG in all-cohort and also amongst genders in a stratified analysis. Multivariate Cox regression (for mortality outcome) and multivariate logistic regression (secondary endpoints) models were used to adjust for unbalanced covariates (standardized mean differences > 10%).</p> <p><strong>Results: </strong>BIMA CABG was performed in 39% out of 2424 eligible procedures and in 27% of 460 females. Median and maximum follow-up times were 5.5 and 12 years, respectively. No differences were found in survival after BIMA and SIMA CABG (IPW hazard ratio: 1.10; 95% confidence interval: 0.68-1.80, p=0.69). A statistically significant interaction between study group and gender was observed (P<0.001). Females who underwent BIMA CABG showed higher mortality (IPW and adjusted hazard ratio in females subset: 3.16; 95% confidence interval: 1.56–6.29, P=0.001). BIMA CABG showed a higher incidence of reoperation due to SWC (IPW model odds ratio: 1.74; 95% CI: 1.16–2.60) that was mostly ascribable to males (IPW and adjusted odds ratio in males: 3.10; 95% CI: 1.74-5.51, P<0.001).</p> <p><strong>Conclusions:</strong> Females may experience higher mortality after BIMA CABG which should be further explored. </p>
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