Background:

Ethnicity is not incorporated into standardized pre-operative risk-stratification tools for cardiac surgery. This study compared short-term outcomes following coronary artery bypass graft (CABG) surgery in South Asian and non-Asian patients.

Methods:

Consecutive patients undergoing isolated CABG surgery via sternotomy between the years 2011 and 2019 were retrospectively analyzed. Initially, 1957 patients were identified (799 South-Asian, 40.8%). The patient groups were then propensity matched according to 10 relevant pre-operative covariates (age, body mass index, pulmonary disease, renal failure, smoking, diabetes, ventricular function, renal failure): 675 non-Asian patients were matched against 675 Asian patients.

Results:

Operative mortality was 1.77% and similar between the two groups (p = 0.447). Multivariate regression analysis found predictors of operative mortality to be pre-operative serum creatinine, age, left ventricular (LV) impairment, and extent of coronary disease. The effect of creatinine on mortality was selective for South-Asian patients (p = 0.015). LV impairment was a predictor of mortality in non-Asian patients, however this effect did not exist in South-Asian patients. Predictors of short-term complications (composite of death, stroke, reoperation, hemofiltration, and pneumonia) were age and creatinine (coefficient 0.002, 95% CI 0.0004–0.004, p = 0.019) in the overall cohort. Subgroup analysis found age to remain a selective negative predictor of complications in South-Asian patients. Cox regression analysis found creatinine, age, and LVEF to influence 10-year survival, whilst ethnicity was not a predictor.

Conclusion:

This study highlights the cumulative risk associated with ethnicity and renal disease in predicting short-term outcomes following CABG. This warrants further investigations in larger populations, thus guiding pre-operative risk-stratification.

中文翻译：

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南亚社区 CABG 后结果的预测因素：倾向匹配分析

 背景：

种族未纳入心脏手术标准化术前风险分层工具中。本研究比较了南亚和非亚裔患者冠状动脉搭桥术 (CABG) 手术后的短期结果。

 方法：

对 2011 年至 2019 年期间连续接受经胸骨切开术进行孤立 CABG 手术的患者进行回顾性分析。最初，确定了 1957 名患者（799 名南亚人，占 40.8%）。然后根据 10 个相关的术前协变量（年龄、体重指数、肺部疾病、肾衰竭、吸烟、糖尿病、心室功能、肾衰竭）对患者组进行倾向匹配：675 名非亚洲患者与 675 名亚洲患者进行匹配。

 结果：

两组的手术死亡率为 1.77%，相似 (p = 0.447)。多变量回归分析发现，术前血清肌酐、年龄、左心室（LV）损伤和冠心病程度是手术死亡率的预测因素。肌酐对南亚患者死亡率的影响是选择性的（p = 0.015）。左心室损伤是非亚洲患者死亡率的预测因素，但这种效应在南亚患者中并不存在。整个队列中短期并发症（死亡、中风、再次手术、血液滤过和肺炎的综合）的预测因素是年龄和肌酐（系数 0.002，95% CI 0.0004-0.004，p = 0.019）。亚组分析发现，年龄仍然是南亚患者并发症的选择性负面预测因素。 Cox 回归分析发现，肌酐、年龄和 LVEF 会影响 10 年生存率，而种族并不是预测因素。

 结论：

这项研究强调了在预测 CABG 后短期结果时与种族和肾脏疾病相关的累积风险。这需要在更大的人群中进行进一步的调查，从而指导术前风险分层。