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Published on: May 14, 2013
Sex Differences in Arterial Grafting in Patients Undergoing Dialysis and Coronary Artery Bypass Grafting
Christine Yang1, Sameer Singh1, Darina Kirilina2
1Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York.
Insights
This study found that while left internal mammary artery (LIMA) grafting improved survival for both men and women undergoing coronary artery bypass grafting (CABG), men had better long-term survival outcomes than women, especially with multiarterial grafting (MAG).
Area of Science:
- Cardiovascular Surgery
- Nephrology
- Health Services Research
Background:
- Patients with kidney failure on dialysis face higher risks during coronary artery bypass grafting (CABG).
- Outcomes for women undergoing coronary revascularization are generally worse than for men.
- The specific outcomes for female patients with kidney failure undergoing CABG, particularly with multiarterial grafting (MAG), are understudied.
Purpose of the Study:
- To compare the 5-year survival rates between men and women with kidney failure undergoing dialysis who received arterial grafting during CABG.
- To evaluate the effectiveness of different grafting strategies, including left internal mammary artery (LIMA) and multiarterial grafting (MAG), in this patient population.
Main Methods:
- A retrospective, population-based cohort study utilizing data from the United States Renal Data System (USRDS) from October 2015 to December 2020.
- Included patients receiving hemodialysis who underwent isolated CABG, excluding those who received a kidney transplant before CABG.
- Grafting patterns analyzed included LIMA plus saphenous vein grafting (SVG) vs. SVG only, and LIMA vs. MAG, with 5-year mortality as the primary outcome.
Main Results:
- Left internal mammary artery (LIMA) grafting was associated with better 5-year survival than SVG only in both men and women.
- LIMA grafting did not show a significant survival benefit compared to multiarterial grafting (MAG) in either sex.
- Men demonstrated significantly better 5-year survival than women following LIMA grafting and MAG, but not for SVG only procedures.
Conclusions:
- Female patients with kidney failure undergoing CABG did not show a survival benefit from arterial grafting compared to male counterparts.
- While LIMA grafting improved survival for both sexes, men exhibited better long-term survival than women, particularly with MAG.
- Further research is needed to understand and address the sex-based disparities in outcomes for this high-risk patient group.
Importance:
Patients with kidney failure undergoing dialysis have increased morbidity and mortality when undergoing coronary artery bypass grafting (CABG). Women also have increased morbidity and mortality compared with men after coronary revascularization; however, outcomes for female patients with kidney failure undergoing dialysis remain understudied, particularly with multiarterial grafting (MAG) during CABG.
Objective:
To compare 5-year survival following arterial grafting among men vs women with kidney failure undergoing dialysis.
Design, Setting, And Participants:
This retrospective, population-based cohort study used United States Renal Data System data from October 15, 2015, to December 31, 2020, to identify patients receiving hemodialysis who underwent isolated CABG. Patients receiving a kidney transplant before CABG were excluded. Data analysis was performed from December 1, 2024, to December 31, 2025.
Exposure:
CABG graft patterns were divided as left internal mammary artery (LIMA) grafting plus saphenous vein grafting (SVG) vs SVG only and LIMA grafting vs MAG.
Main Outcomes And Measures:
The main outcome of interest was 5-year mortality in risk-adjusted groups. Cohorts were compared in 2 analyses: arterial grafting in men vs SVG only in men, and arterial grafting in women vs SVG only in women. Outcomes in men and women were then directly compared within each choice of conduit.
Results:
There were 15 215 patients in the total unadjusted cohort, with 10 466 men (68.8%) and 4749 women (31.2%) (median [IQR] age, 65.3 [57.2-71.5] years). After inverse probability of treatment weighting adjustment, LIMA grafting was associated with better 5-year survival than SVG only in both men (32.0% [95% CI, 30.7%-33.3%] vs 27.3% [95% CI, 23.2%-32.2%]; P < .001) and women (30.7% [95% CI, 28.9%-32.6%] vs 25.3% [95% CI, 20.3%-31.5%]; P = .002). LIMA grafting was not associated with a survival benefit at 5 years compared with MAG in men (32.1% [95% CI, 30.8%-33.4%] vs 35.9% [95% CI, 29.2%-44.1%]; P = .45) or women (30.6% [95% CI, 28.9%-32.5%] vs 17.3% [95% CI, 9.9%-30.5%]; P = .08). Comparing sexes by grafting type, men had significantly better 5-year survival than women following LIMA grafting overall (32.1% [95% CI, 30.8%-33.4%] vs 30.5% [95% CI, 28.7%-32.5%]; P < .001) and following LIMA grafting among patients who survived to hospital discharge (34.0% [95% CI, 32.7%-35.5%] vs 33.7% [95% CI, 31.8%-35.7%]; P < .001). Men had significantly better 5-year survival compared with women following MAG (38.5% [95% CI, 32.1%-46.2%] vs 17.0% [95% CI, 9.2%-31.2%]; P = .002). There was no significant 5-year survival difference between men and women among those who received SVG only (28.4% [95% CI, 24.3%-33.2%] vs 25.2% [95% CI, 20.3%-31.2%]; P = .21).
Conclusions And Relevance:
Although sample sizes were small in some subgroups, female patients were not associated with a survival benefit from arterial grafting compared with their male counterparts. Although both men and women were associated with better long-term survival following LIMA grafting, men appeared to have better long-term survival than women following LIMA grafting and MAG.
