Objective

The study objective was to investigate the impact of multiple arterial grafting on long-term all-cause mortality in women undergoing isolated coronary artery bypass grafting.

Methods

A comprehensive search was performed to identify observational studies reporting outcomes after coronary artery bypass grafting reported by sex and stratified into multiple arterial grafting versus single arterial grafting strategies. Articles were considered for inclusion if they were written in English and were propensity-matched observational studies. Included studies were then pooled in a meta-analysis performed using the generic inverse variance method. The primary outcome was long-term all-cause mortality. Secondary outcomes were operative mortality and spontaneous myocardial infarction. Meta-regression was used to explore the effects of preoperative and intraoperative variables on the primary outcome.

Results

A total of 6 studies with 32,793 women (25,714 single arterial grafting and 7079 multiple arterial grafting) were included. Women who received multiple arterial grafting had lower long-term mortality (incidence rate ratio, 0.86; 95% confidence interval, 0.76-0.96; P = .007) and spontaneous myocardial infarction (incidence rate ratio, 0.80; 95% confidence interval, 0.68-0.93; P = .003) compared with women who received single arterial grafting, but the difference in mortality disappeared when including only the 3 largest studies. There was no difference between groups in operative mortality (odds ratio, 0.99; 95% confidence interval, 0.84-1.17; P = .91). Meta-regression did not identify any associations with the incidence rate ratio for long-term mortality.

Conclusions

The use of multiple arterial grafting in women undergoing coronary artery bypass grafting is associated with lower long-term mortality, although the difference is mostly driven by small series. Further studies, including randomized trials, are needed to evaluate the efficacy of multiple arterial grafting in women undergoing coronary artery bypass grafting.

中文翻译：

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女性单动脉移植与多动脉移植的冠状动脉搭桥：一项荟萃分析

客观的

该研究的目的是调查多动脉移植对接受离体冠状动脉旁路移植术的女性长期全因死亡率的影响。

方法

进行了一项全面的搜索，以确定报告冠状动脉旁路移植术后结果的观察性研究，按性别报告，并分层为多动脉移植与单动脉移植策略。如果文章是用英语写的并且是倾向匹配的观察性研究，则考虑将其纳入。然后将纳入的研究汇总到使用通用逆方差方法进行的荟萃分析中。主要结局是长期全因死亡率。次要结局是手术死亡率和自发性心肌梗死。荟萃回归用于探讨术前和术中变量对主要结局的影响。

结果

总共纳入了 6 项研究，涉及 32,793 名女性（25,714 名单动脉移植患者和 7079 名多动脉移植患者）。接受多动脉移植的女性的长期死亡率（发病率比，0.86；95% 置信区间，0.76-0.96；P  = 0.007）和自发性心肌梗死（发病率比，0.80；95% 置信区间，0.68）较低。 -0.93；P  = .003）与接受单动脉移植的女性相比，但当仅包括 3 项最大的研究时，死亡率差异消失。各组之间的手术死亡率没有差异（比值比，0.99；95% 置信区间，0.84-1.17；P  = .91）。荟萃回归未发现与长期死亡率的发生率有任何关联。

结论

在接受冠状动脉旁路移植术的女性中使用多动脉移植术与较低的长期死亡率相关，尽管这种差异主要是由小系列研究造成的。需要进一步的研究，包括随机试验，来评估多动脉移植对接受冠状动脉旁路移植术的女性的疗效。