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Is sex a risk factor for death in patients with bilateral internal thoracic artery grafts?
Juan Mariano Vrancic1, Daniel Oscar Navia1, Juan Carlos Espinoza1
1Department of Cardiac Surgery, Instituto Cardiovascular De Buenos Aires, Buenos Aires, Argentina.
Insights
Bilateral internal thoracic artery (BITA) grafting offers women long-term survival comparable to men after coronary artery bypass grafting (CABG). This surgical approach benefits older women, particularly those over 65, improving their survival rates.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Surgical Outcomes
Background:
- Higher mortality rates have been observed in women undergoing coronary artery bypass grafting (CABG).
- The potential survival benefit of bilateral internal thoracic artery (BITA) grafting in women compared to single internal thoracic artery grafting requires investigation.
- Assessing BITA grafting's long-term efficacy in women is crucial for optimizing cardiac surgical outcomes.
Purpose of the Study:
- To evaluate the long-term survival benefit of bilateral internal thoracic artery (BITA) grafting in women undergoing coronary artery bypass grafting (CABG).
- To compare the survival outcomes of women receiving BITA grafts with those of men receiving BITA grafts.
- To determine if female sex is an independent risk factor for late mortality after CABG with BITA grafting.
Main Methods:
- Retrospective analysis of a prospectively collected database of 4406 patients undergoing isolated CABG between January 2000 and April 2017.
- Inclusion criteria focused on patients receiving either BITA grafts (2979 patients) or single internal thoracic artery grafts.
- Analysis included in-hospital and follow-up mortality, with multivariable Cox proportional hazard analyses to identify predictors of late mortality, including age stratification.
Main Results:
- Bilateral internal thoracic artery (BITA) grafting in women demonstrated long-term survival equivalent to that of men (P=0.784).
- Female sex was not identified as an independent risk factor for late death (HR, 0.739; P=0.189) in Cox proportional hazard models.
- Stratification analysis revealed that the beneficial effect of BITA grafting remained consistent across sexes and age groups, with superior survival observed in patients over 65 years receiving BITA grafts compared to single internal thoracic artery grafts.
Conclusions:
- Bilateral internal thoracic artery (BITA) grafting in women is associated with similar long-term survival compared to men, irrespective of certain demographic and procedural differences.
- Female sex does not independently predict late mortality following CABG when utilizing BITA grafting.
- BITA grafting provides a survival advantage for women, particularly those over 65 years of age, highlighting its efficacy in this demographic.
Background:
Mortality after coronary artery bypass grafting (CABG) has been reported to be higher in women. The aim of this study was to evaluate whether bilateral internal thoracic artery (BITA) grafting in women has a long-term survival benefit over single internal thoracic artery grafting, possibly equivalent to the male population.
Methods:
A retrospective review was undertaken of our prospectively collected database. We included 4406 consecutive patients who underwent isolated CABG, who received their operation between January 2000 and April 2017. From the entire series, 2979 patients (67.6%) received exclusively BITA grafts; 299 (10.1%) were female. The primary end point was follow-up mortality, independently from cause. In-hospital mortality and during follow-up were analyzed. Substratification according to age was performed to answer whether it has an effect. Multivariable Cox proportional hazard analyses was performed to investigate the significant predictors of late mortality.
Results:
The median follow-up was 5.1 ± 3.9 years. Female BITA patients were older (P < .001), had nonelective surgery (P < .001), more on-pump CABG (P = .015), fewer number of grafts (P < .001) versus male BITA patients. BITA grafting in women had a long-term survival equivalent to that of men (P = .784). In a Cox proportional hazard model, female sex was not an independent risk factor for late death (B, -0.303; hazard ratio, 0.739; 95% confidence interval, 0.470-1.16; P = .189). The stratification analysis showed that the beneficial effect of BITA remained similar among sexes and was not modified by age even after adjusting for confounders. In a risk-adjusted sample, patients older than 65 years with BITA grafting showed superior long-term survival than those with single internal thoracic artery grafting (P = .019).
Conclusions:
Although there are some differences between sexes, BITA grafting in women was associated with similar 10-year survival compared with men, and female sex was not an independent risk factor for late death. Among women, the BITA group had better survival, especially those older than 65 years.
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