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Sex Differences in Coronary Artery Bypass Grafting Techniques: A Society of Thoracic Surgeons Database Analysis
Oliver K Jawitz1, Jennifer S Lawton2, Dylan Thibault3
1Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
Insights
Female patients with coronary artery disease (CAD) receive guideline-concordant coronary artery bypass graft (CABG) surgery less often. This study found lower odds of optimal revascularization techniques in women, potentially impacting outcomes.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Sex Differences in Medicine
Background:
- Female patients with coronary artery disease (CAD) experience worse outcomes than males after coronary artery bypass graft (CABG) surgery.
- Disparities in surgical approaches may contribute to sex-based differences in CAD outcomes.
Purpose of the Study:
- To investigate the association between female sex and the utilization of guideline-concordant CABG revascularization techniques.
- To determine if women are less likely to receive optimal surgical strategies for CAD.
Main Methods:
- Analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database (2011-2019).
- Inclusion of adult patients undergoing first-time isolated CABG in the United States.
- Assessment of the association between female sex and specific revascularization techniques, including left internal mammary artery (LIMA) grafting, complete revascularization, and multiarterial grafting, with statistical adjustments.
Main Results:
- A total of 1,212,487 patients were analyzed (25% female).
- Female patients had significantly lower odds of receiving LIMA grafts to the left anterior descending artery (aOR 0.79), complete revascularization (aOR 0.86), and multiarterial grafting (aOR 0.78) compared to males.
- These disparities represent a 14% to 22% lower likelihood of guideline-concordant revascularization in women.
Conclusions:
- Female sex is associated with reduced odds of receiving optimal, guideline-concordant CABG revascularization.
- Further research is needed to understand the reasons for these sex-based differences in surgical approaches.
- Investigating these disparities is crucial to addressing sex differences in CAD outcomes.
Background:
Female patients with coronary artery disease have inferior outcomes compared with male patients, including higher mortality after coronary artery bypass graft surgery (CABG). We aimed to evaluate the association of female sex with the use of guideline-concordant CABG revascularization techniques.
Methods:
The Society of Thoracic Surgeons Adult Cardiac Surgery Database was queried for adult patients who underwent first-time isolated CABG in the United States from 2011 to 2019. The association between female sex and the odds of (1) receiving a left internal mammary artery graft for revascularization of the left anterior descending artery, (2) undergoing complete revascularization, and (3) undergoing multiarterial grafting was assessed, adjusting for procedural anatomy.
Results:
Among 1,212,487 patients meeting inclusion criteria, 75% were male (n = 911,178) and 25% were female (n = 301,309). Female sex was associated with lower unadjusted rates of revascularization with an internal mammary artery graft (93.9% vs 95.9%, P < .001), bilateral internal mammary artery graft (2.9% vs 5.6%, P < .001), or radial artery graft (3.2% vs 5.6%, P < .001). After adjustment, female patients had lower odds than males of receiving a left internal mammary artery graft to the left anterior descending artery (adjusted odds ratio 0.79; 95% confidence interval, 0.75 to 0.83; P < .001), undergoing complete revascularization (adjusted odds ratio 0.86; 95% confidence interval, 0.83 to 0.90; P < .001), and undergoing multiarterial grafting (adjusted odds ratio 0.78; 95% confidence interval, 0.75 to 0.81; P < .001).
Conclusions:
Female sex was associated with 14% to 22% lower odds of undergoing guideline-concordant revascularization including left internal mammary artery to left anterior descending artery grafting, multiarterial grafting, and complete revascularization. Further investigation is necessary to determine why revascularization approaches differ by sex and to what degree sex disparities in coronary artery disease outcomes are due to surgical approach.
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