期刊
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
卷 166, 期 2, 页码 532-+出版社
MOSBY-ELSEVIER
DOI: 10.1016/j.jtcvs.2021.10.067
关键词
sternal wound complications; coronary artery bypass grafting; long-term mortality
This study evaluated the association between sternal wound complications (SWC) and long-term mortality in the Arterial Revascularization Trial. The results showed that postoperative SWC was significantly associated with long-term mortality and increased rates of major adverse cardiovascular events.
Objective: To evaluate the association between sternal wound complications (SWC) and long-term mortality in the Arterial Revascularization Trial.Methods: Participants in the Arterial Revascularization Trial were stratified according to the occurrence of postoperative SWC. The primary outcome was all-cause mortality at long-term follow-up. The secondary outcome was major adverse cardiovascular events. Results: Three thousand one hundred two patients were included in the analysis; the median follow-up was 10 years. 115 patients (3.7%) had postoperative SWC: 85 (73.9%) deep sternal wound infections and 30 (26.1%) sterile SWC that required sternal reconstruction. Independent predictors of SWC included diabetes (odds ratio [OR], 2.77; 95% CI, 1.79-4.30; P <.001), female sex (OR, 2.73; 95% CI, 1.71-4.38; P <.001), prior stroke (OR, 2.59; 95% CI, 1.12-5.98; P = .03), chronic obstructive pulmonary disease (OR, 2.44; 95% CI, 1.60-3.71; P <.001), and use of bilateral internal thoracic artery (OR, 1.70; 95% CI, 1.12-2.59; P = .01). Postoperative SWC was significantly associated with long-term mortality. The Kaplan-Meier survival estimate was 91.3% at 5 years and 79.4% at 10 years in patients without SWC, and 86.1% and 64.3% in patients with SWC (log rank P <.001). The rate of major adverse cardiovascular events was also higher among patients who had SWC (n = 51 [44.3%] vs 758 [25.4%]; P < .001). Using multivariable analysis, the occurrence of SWC was independently associated with long-term mortality (hazard ratio, 1.81; 95% CI, 1.30-2.54; P < .001).Conclusions: In the Arterial Revascularization Trial, postoperative SWC although uncommon were significantly associated with long-term mortality. (J Thorac Cardiovasc Surg 2023;166:532-9)
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