Abstract：
BACKGROUND: The impact of sex-differences on the release of cardiac biomarkers after coronary artery bypass grafting (CABG) remains unknown. The aim of our study was to (a) investigate the impact of sex-differences in cardiac biomarker release after CABG and (b) determine sex-specific thresholds for high-sensitivity troponin (hs-cTn) and creatine kinase-MB (CK-MB) associated with 30-day major adverse cardiovascular event (MACE) and mortality.
METHODS: A consecutive cohort of 3687 patients (female: n= 643 (17.4%); male: 3044 (82.6%) undergoing CABG from 2008-2021 in two tertiary university centers with serial postoperative cTn and CK-MB measurement was analyzed. The composite primary outcome was MACE at 30 days. Secondary endpoints were 30-day mortality and five-year mortality and MACE. Sex-specific thresholds for cTn and CK-MB were determined.
RESULTS: Lower levels of cTn were found in women after CABG (69.18 vs. 77.57 xURL; p<0.001). Optimal threshold value for cTn was calculated at 94.36 times the URL for female and 206.07 times the URL for male patients to predict 30-day MACE. Female patients missed by a general threshold had increased risk for MACE or death within 30 days (cTn: MACE: OR 3.78 CI: 1.03-13.08; p=0.035; death: OR 4.98; CI: 1.20.-20.61; p=0.027; CK-MB: MACE: OR 10.04; CI: 2.07-48.75; p<0.001; death: OR 13.59; CI: 2.66-69.47; p=0.002).
CONCLUSIONS: We provide evidence for sex-specific differences in the outcome and biomarker release after CABG. Sex-specific cut-offs are necessary for the diagnosis of perioperative myocardial injury to improve outcomes of women after CABG.
METHODS: A consecutive cohort of 3687 patients (female: n= 643 (17.4%); male: 3044 (82.6%) undergoing CABG from 2008-2021 in two tertiary university centers with serial postoperative cTn and CK-MB measurement was analyzed. The composite primary outcome was MACE at 30 days. Secondary endpoints were 30-day mortality and five-year mortality and MACE. Sex-specific thresholds for cTn and CK-MB were determined.
RESULTS: Lower levels of cTn were found in women after CABG (69.18 vs. 77.57 xURL; p<0.001). Optimal threshold value for cTn was calculated at 94.36 times the URL for female and 206.07 times the URL for male patients to predict 30-day MACE. Female patients missed by a general threshold had increased risk for MACE or death within 30 days (cTn: MACE: OR 3.78 CI: 1.03-13.08; p=0.035; death: OR 4.98; CI: 1.20.-20.61; p=0.027; CK-MB: MACE: OR 10.04; CI: 2.07-48.75; p<0.001; death: OR 13.59; CI: 2.66-69.47; p=0.002).
CONCLUSIONS: We provide evidence for sex-specific differences in the outcome and biomarker release after CABG. Sex-specific cut-offs are necessary for the diagnosis of perioperative myocardial injury to improve outcomes of women after CABG.
摘要：
背景：性别差异对冠状动脉旁路移植术（CABG）后心脏生物标志物释放的影响尚不清楚。我们研究的目的是（a）研究CABG后心脏生物标志物释放的性别差异的影响，以及（b）确定与30天主要不良心血管事件（MACE）和死亡率相关的高敏肌钙蛋白（hs-cTn）和肌酸激酶-MB（CK-MB）的性别特异性阈值。
方法：分析了连续的3687例患者（女性：n=643（17.4％）；男性：3044（82.6％），2008-2021年在两个高等教育中心进行CABG，并进行了连续的术后cTn和CK-MB测量。复合主要结局是30天的MACE。次要终点是30天死亡率和5年死亡率和MACE。确定cTn和CK-MB的性别特异性阈值。
结果：CABG后女性cTn水平较低（69.18vs.77.57xURL；p<0.001)。cTn的最佳阈值是女性患者的URL的94.36倍和男性患者的URL的206.07倍，以预测30天的MACE。超过一般阈值的女性患者在30天内发生MACE或死亡的风险增加(cTn:MACE:OR3.78CI:1.03-13.08;p=0.035;死亡:OR4.98;CI:1.20。-20.61;p=0.027;CK-MB：MACE：OR10.04;CI：2.07-48.75;p<0.001;死亡：OR13.59;CI：2.66-69.47;p=0.002）。
结论：我们提供了CABG后结果和生物标志物释放的性别特异性差异的证据。性别特异性截断值对于围手术期心肌损伤的诊断是必要的，以改善CABG术后妇女的预后。
方法：分析了连续的3687例患者（女性：n=643（17.4％）；男性：3044（82.6％），2008-2021年在两个高等教育中心进行CABG，并进行了连续的术后cTn和CK-MB测量。复合主要结局是30天的MACE。次要终点是30天死亡率和5年死亡率和MACE。确定cTn和CK-MB的性别特异性阈值。
结果：CABG后女性cTn水平较低（69.18vs.77.57xURL；p<0.001)。cTn的最佳阈值是女性患者的URL的94.36倍和男性患者的URL的206.07倍，以预测30天的MACE。超过一般阈值的女性患者在30天内发生MACE或死亡的风险增加(cTn:MACE:OR3.78CI:1.03-13.08;p=0.035;死亡:OR4.98;CI:1.20。-20.61;p=0.027;CK-MB：MACE：OR10.04;CI：2.07-48.75;p<0.001;死亡：OR13.59;CI：2.66-69.47;p=0.002）。
结论：我们提供了CABG后结果和生物标志物释放的性别特异性差异的证据。性别特异性截断值对于围手术期心肌损伤的诊断是必要的，以改善CABG术后妇女的预后。
