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[Coronary heart surgery in women: the risk factors and short-term results]
P Nardi1, A Pellegrino, R De Paulis
1Cattedra di Cardiochirurgia, Università degli Studi Tor Vergata, Roma.
Insights
Coronary artery bypass grafting (CABG) outcomes show women do not have higher mortality than men, despite presenting with more comorbidities. Refined surgical techniques and internal thoracic artery use likely contribute to these findings.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Medical Research
Background:
- Coronary artery bypass grafting (CABG) traditionally shows higher mortality in women (2-3x).
- Preoperative factors like older age, hypertension, diabetes, smaller artery diameter, and body surface area contribute to this disparity.
- Existing literature suggests increased operative risk for women undergoing CABG.
Purpose of the Study:
- To investigate operative risk and early outcomes of isolated coronary artery bypass grafting (CABG) in women versus men.
- To identify potential factors contributing to differences in CABG outcomes between sexes.
- To evaluate the impact of surgical techniques and patient characteristics on CABG mortality.
Main Methods:
- A retrospective study of 347 female and 2098 male patients undergoing isolated CABG from 1992-1997.
- Analysis included clinical presentation, cardiovascular risk factors, concomitant diseases, hemodynamic/anatomical data, and surgical procedures.
- Early results (up to 30 days) were assessed for complications and mortality.
Main Results:
- Women were older, shorter, lighter, with smaller body surface area, and higher rates of angina, diabetes, hypercholesterolemia, and thyroid dysfunction.
- Women had smaller coronary arteries and received fewer grafts, but internal thoracic artery use was similar.
- Overall mortality was comparable: 4.6% for women versus 3.2% for men; no extraoperative risk factors identified for women.
Conclusions:
- Coronary artery bypass grafting (CABG) does not appear to carry a significantly higher operative risk for women compared to men.
- Surgical technique refinements and increased utilization of the internal thoracic artery may explain the lack of increased risk in women.
- Findings challenge previous literature suggesting higher CABG mortality in female patients.
Background:
Coronary artery bypass grafting is reported to have a higher (2-3 times) mortality in women than in men, most likely due to older age, higher incidence of hypertension, diabetes mellitus, hypercholesterolemia, obesity, angina and preoperative myocardial infarction, smaller diameter of coronary arteries, and smaller body surface area.
Methods:
From January 1992 to December 1997, 347 female and 2098 male patients were submitted to isolated coronary artery bypass grafting. For both groups were considered: a) clinical presentation (age, height, weight, body surface area, NYHA and CCS functional classes, incidence of preoperative myocardial infarction); b) risk factors for cardiovascular diseases (diabetes mellitus, smoking habit, dyslipidemia, hypertension, familiarity); c) concomitant diseases (obesity, chronic obstructive pulmonary disease, peripheral vascular disease, thyroid dysfunction); d) hemodynamic and anatomical data (extent of coronary artery disease, diameter of coronary arteries, left ventricular function); e) surgical procedure (number and type of grafts used, urgent procedures, incidence of redo procedures). Early (up to 30 days after surgery) results were evaluated in terms of complications and mortality.
Results:
On admission, women were older than men (p = 0.0001), were shorter (p < 0.0001), weighed less (p < 0.0001), and had a smaller body surface area (p < 0.0001); they had more severe angina (p = 0.002), diabetes mellitus (p = 0.002), hypercholesterolemia (p = 0.003), thyroid dysfunction (p < 0.0001), their coronary arteries were smaller (left anterior descending artery, p = 0.05; obtuse marginal branch, p = 0.008; diagonal branch, p = 0.01), and had less grafts implanted at surgery (p = 0.02). There was no difference between women and men in the use of the internal thoracic artery. Women did not have a higher mortality than men (4.6 vs 3.2%). Uni- and multivariate analysis did not show extraoperative risk factors for women; for men older age (p = 0.005) and poor left ventricular function (p = 0.01) were independent predictive factors of operative mortality.
Conclusions:
In spite of what is suggested by the literature, coronary artery bypass grafting does not have a significant higher operative risk for women than men, probably due to surgical technique refinements and extensive use of the internal thoracic artery.