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[Immediate Outcomes of Coronary Artery Bypass Grafting in Patients With Multifocal Atherosclerosis: Gender
A N Sumin1, E V Korok1, R A Gaifulin1
1Research Institute for Complex Problems of Cardiovascular Diseases, Kemerovo, Russia.
Insights
Multifocal atherosclerosis (MFA) and gender do not impact perioperative complications after coronary artery bypass grafting (CABG). However, a history of CABG and specific coronary artery involvement increase risks for complications and mortality.
Area of Science:
- Cardiovascular Surgery
- Vascular Surgery
- Cardiology
Background:
- Ischemic heart disease (IHD) management often involves coronary artery bypass grafting (CABG).
- Multifocal atherosclerosis (MFA) and patient demographics, including gender, may influence surgical outcomes.
- Understanding these factors is crucial for optimizing patient care and risk stratification.
Purpose of the Study:
- To evaluate the impact of multifocal atherosclerosis (MFA) and gender on immediate outcomes following coronary artery bypass grafting (CABG).
- To identify specific patient characteristics and disease patterns associated with adverse events after CABG.
Main Methods:
- Retrospective review of medical records for 764 patients undergoing elective CABG for IHD with MFA.
- Analysis of demographic, clinical, and angiographic data.
- Multivariate analysis to determine predictors of perioperative complications and in-hospital mortality.
Main Results:
- Women presented with more comorbidities (e.g., diabetes, overweight, heart failure) and higher rates of carotid artery stenosis.
- Men showed a higher prevalence of reduced left ventricular ejection fraction and peripheral artery disease.
- No significant gender differences in overall perioperative complication rates were observed (48.8% in women vs. 53.0% in men).
- History of prior CABG was linked to increased perioperative complications (p=0.034).
- Combined involvement of the left main coronary artery (LMCA) and three coronary arteries significantly increased in-hospital mortality (p=0.003).
Conclusions:
- Perioperative complication rates after CABG did not differ significantly between genders.
- Women exhibited a distinct comorbidity profile and lesion distribution compared to men.
- Independent risk factors for adverse outcomes include prior CABG, LMCA involvement, and three-vessel disease, irrespective of gender or MFA presence.
Aim:
To assess the impact of presence of multifocal atherosclerosis (MFA) and gender differences on immediate outcomes after coronary artery bypass grafting (CABG) in patients with ischemic heart disease (IHD).
Material And Methods:
Medical records of patients with MFA, who underwent elective CABG (n=764, 655 men, 109 women) were reviewed retrospectively.
Results:
Women were older (<0.001), and more often were overweight (<0.001), had diabetes (<0.001), high angina functional class (=0.012) and congestive heart failure (=0.002). Cigarette smoking was more common among men. Men more often had reduced left ventricular ejection fraction (<0.001). Three-vessel coronary artery disease prevailed among women (=0.080). Rate of hemodynamically significant carotid stenosis was higher among women (=0.010), whereas that of peripheral artery disease - among men (=0.001). Total number of perioperative complications was 48.8% among women and 53.0% among men (=0.399). According to multivariate analysis, history of CABG was associated with increased risk of perioperative complications (=0.034), and combined involvement of left main coronary artery (LMCA) and three coronary arteries - with in-hospital mortality (=0.003).
Conclusion:
There were no gender differences in the incidence of perioperative complications. Women more often had carotid lesions, men - lesions in arteries of lower limbs. Women had more risk factors (other than smoking) what could explain high prevalence of three-vessel disease as well as more severe coronary insufficiency and heart failure. Regardless of patients gender and presence of MFA history of previous CABG and presence of combined LMCA and three coronary arteries involvement increased risk of perioperative complications and in-hospital mortality, respectively.
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