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Reduced efficacy of coronary artery bypass grafting in women
Insights
Women undergoing coronary artery bypass grafting (CABG) had higher mortality and lower survival rates compared to men. Female gender, older age, and comorbidities significantly influenced hospital mortality in CABG patients.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Surgical Risk Factors
Background:
- Coronary artery bypass grafting (CABG) is a common surgical procedure for coronary heart disease.
- Understanding patient demographics and preoperative factors influencing outcomes is crucial for risk stratification.
- Previous studies have suggested potential gender-based differences in CABG outcomes.
Purpose of the Study:
- To compare the outcomes of isolated, primary, elective coronary artery bypass grafting (CABG) between male and female patients.
- To identify preoperative and perioperative factors associated with hospital mortality and long-term survival in CABG patients.
Main Methods:
- Retrospective analysis of 1,089 patients undergoing primary, elective CABG between August 1978 and May 1985.
- Comparison of demographic data, preoperative comorbidities, and perioperative outcomes between men and women.
- Univariate and multivariate analyses to identify predictors of hospital mortality and long-term survival.
Main Results:
- Women were older, had more severe angina, and higher incidences of diabetes and congestive heart failure compared to men.
- Overall hospital mortality was 1.9%, with significantly higher mortality in women (4.3%) versus men (1.2%).
- Female gender, advanced age, left ventricular dysfunction, congestive heart failure, renal insufficiency, peripheral and extracranial occlusive disease, and COPD were associated with increased hospital mortality. Perioperative myocardial infarction, low cardiac output, and respiratory failure also significantly influenced outcomes. Five-year survival was 90%, with men having superior overall and event-free survival.
Conclusions:
- Female gender is an independent predictor of increased hospital mortality following CABG.
- Women undergoing CABG present with more comorbidities and experience worse short-term and long-term outcomes compared to men.
- Risk stratification models for CABG should incorporate gender as a significant factor.
Abstract:
During a six-year period (August, 1978-May, 1985), 1,089 patients underwent isolated, primary, elective coronary artery bypass grafting (CABG) at St. Margaret's Hospital, Montgomery, Alabama. The group consisted of 833 (76.5%) men and 256 (23.5%) women. The women were older (mean age, 59.7 years vs. 55.4 years for men) (p = .0001), had more severe preoperative angina pectoris (mean New York Heart Association functional class 3.3 vs. 3.1) (p = .008), and had higher incidences of adult-onset diabetes mellitus (24% vs. 13.5%) (p = .0001) and preoperative congestive heart failure (8.2% vs. 3.7%) (p = .003). The overall mortality was 1.9% (21/1,089 patients); there were 10 deaths among the men (1.2%) and 11 deaths among the women (4.3%) (p = .001). Univariate and multivariate analysis of preoperative variables indicated that the female gender factor (p = .002), age of 70 years or older at operation (p less than .001), preoperative left ventricular dysfunction (p = .026), preoperative congestive heart failure (p less than .001), renal insufficiency (p = .036), peripheral occlusive disease (p = .002), extracranial occlusive disease (p = .001), and chronic obstructive pulmonary disease (p = 0.17) all had significant influences on hospital mortality. Perioperative myocardial infarction (p = .017), low cardiac output (p less than .001), and respiratory failure (p less than .001) significantly influenced outcome as well. Long-term (five-year) overall survival (90%) indicates a significantly superior overall survival among men (p = .0008). Event-free survival (absence of cardiac death, myocardial infarction, or recurrent angina pectoris) was significantly superior among the men (p = .03) as well.(ABSTRACT TRUNCATED AT 250 WORDS)