Higher mortality in women undergoing coronary artery bypass grafting

Abstract

Aims While men have higher rates of cardiovascular disease, several studies report women having higher mortality after cardiac surgery, reasons for which are unclear. We compared characteristics and outcomes of coronary artery bypass grafting (CABG) by sex. Methods All patients undergoing isolated CABG during July 2010-June 2012 were grouped by sex for retrospective analyses. Results A total of 168 (20.5%) women and 650 (79.4%) men were included, followed-up for 1.4±0.6 years. Women were older (66.4 vs 64.0 years; p=0.007), with higher body mass index (30.1 vs 28.8 kg/m 2 ; p=0.004), increased prevalence of hypertension (78.9% vs 67.8%; p=0.008), current smoking (20.2% vs 13.1%; p=0.027), chronic respiratory disease (22.6% vs 15.4%; p=0.028) and estimated glomerular filtration rate (74 vs 81 ml/min/1.73m 2 ; p=0.007). Women had less grafts performed (3.1 vs 3.3; p=0.014) and less use of radial grafts (14.9% vs 25.2%; p=0.004). Female sex was independently associated with higher 30-day mortality (4.8% vs 0.8%) odds ratio 5.63, 95% confidence interval 1.67-19.0; p=0.005 and medium-term mortality hazards ratio 2.49, 1.06-5.84; p=0.037 (1-year survival 93.9% vs 98.1%); but not surgical morbidity (21.4% vs 16.9%; p=0.661). Conclusion Women had higher 30-day and medium-term mortality after CABG even after adjusting for higher prevalence of risk factors and comorbidities. Ischaemic heart disease (IHD) was the single most common cause of death in New Zealand (NZ) at 19.0% in 2009, with 45.3% being women. 1 Coronary artery bypass grafting (CABG) is the standard treatment for patients with severe three-vessel or left main stem coronary disease, and multi-vessel disease in diabetic patients. 2-4 Many, 5-15 but not all 16-19 studies have found women to have higher rates of mortality and morbidity after CABG. Most contemporary operative risk scores therefore include sex as an important parameter for predicting mortality after cardiac surgery. 20,21 However, sex is frequently an underappreciated risk factor in the decision making for CABG and is not included in the New Zealand Access or Urgency Scores. Outcomes according to sex have also not been investigated in a NZ cohort. We aimed to compare characteristics and mortality and morbidity outcomes by sex in a contemporary cohort of New Zealanders undergoing CABG. Methods Ethics-Ethics approval of this study was obtained from our hospital's Ethics Committee. Consecutive patients having isolated CABG without concomitant valve surgery from July 2010 to June 2012 at

Are the Early Postoperative Outcomes of Coronary Artery Bypass Grafting Surgery in Elderly Women Worse Compared to Men's?

“…Almost all studies in the literature reported that female patients undergoing CABG were older and higher risk patients with higher EuroSCORE had more preoperative comorbid conditions such as HT, DM and HL compared to male [ 25 - 28 ] . We also found that female patients had statistically significantly higher EuroSCORE levels, and the incidence of HT and HL were higher than in males.…”

Comparison of Short-Term Results between Patients Undergoing Coronary Artery Bypass Graft with a Stent-Placement History and Patients Undergoing Primary Coronary Artery Surgery

“…However, the authors used on-pump CABG, while we applied off-pump CABG. Several studies have revealed that cardiopulmonary bypass induces an inflammatory response, affecting post-CABG morbidity 15, 16. The difference in the method may have contributed to the discrepancy between the reported results.…”

Nursing Evaluation of Risk Factors Associated with Surgical Site Infection Among Coronary Artery Bypass Graft Patients at King Abdulaziz University Hospital

“…However, the study recruited a young cohort of below 40 years of age, which could explain the higher percentages of smokers. However, study in New Zealand found more women (20.2%) smokers among patients undergoing coronary artery bypass graft surgery compared to male patients (13.1%) [29]. Smoking is a significant risk factor leading to the advancing of surgical site infection and other risk factors such as myocardial infarction, reoperation, and angina pectoris [28].…”