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Published on: March 27, 2018
Effect of coronary artery diameter in patients undergoing coronary bypass surgery. Northern New England
N J O'Connor1, J R Morton, J D Birkmeyer
1Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
Insights
Smaller coronary artery diameter increases mortality risk during coronary artery bypass grafting (CABG). Women have smaller coronary arteries than men, even after accounting for body size, explaining higher CABG risks.
Area of Science:
- Cardiovascular Surgery
- Medical Research
- Human Anatomy
Background:
- Coronary artery diameter inversely correlates with perioperative mortality in coronary artery bypass grafting (CABG).
- Increased CABG risk in women and smaller individuals is hypothesized to stem from smaller coronary vessels.
- Independent effects of sex on coronary vessel size remain largely unexamined due to limited direct coronary size data.
Purpose of the Study:
- To investigate the association between sex, body size, and coronary artery size.
- To determine if sex independently predicts coronary artery size after controlling for body size.
- To explore the relationship between coronary artery diameter and in-hospital mortality following CABG.
Main Methods:
- Prospective data collection on 1325 patients undergoing CABG, including height, weight, sex, age, and mid-left anterior descending (mid-LAD) coronary artery diameter.
- Statistical analysis using multiple linear regression to assess correlations between vessel size and body metrics (body surface area, BMI, height, weight).
- Comparison of mid-LAD diameter between sexes after adjusting for age and body size differences.
Main Results:
- Smaller mid-LAD diameter was significantly associated with increased in-hospital mortality risk.
- Vessel size strongly correlated with sex and body size measures (BSA, BMI, height, weight).
- Men exhibited larger mid-LAD diameters than women, even after controlling for body size (mean difference: 0.14–0.23 mm).
Conclusions:
- Small mid-LAD diameter is a significant predictor of increased in-hospital mortality in CABG patients.
- Women possess smaller coronary arteries than men, independent of body size.
- Findings support the hypothesis that smaller coronary arteries contribute to higher perioperative mortality in women and smaller individuals undergoing CABG.
Background:
Coronary artery diameter is known to be inversely associated with perioperative mortality related to coronary artery bypass grafting (CABG). This association is believed to be responsible for increased risk among women and smaller people. However, the associations between sex, body size, and coronary size have not been carefully examined because direct information about coronary size is rarely available. Also, whether sex has an independent effect on vessel size is largely unknown.
Methods And Results:
Height, weight, sex, age, status at hospital discharge, and luminal diameter of the midleft anterior descending coronary artery (mid-LAD) were recorded prospectively in 1325 patients undergoing CABG. Small vessel size was associated with substantially increased risk of in-hospital mortality (15.8% for 1.0-mm vessels, 4.6% for 1.5- to 2.0-mm vessels, and 1.5% for 2.5- to 3.5-mm vessels, P[trend] < .001). Vessel size was strongly related to both sex and measures of body size. In multiple linear regression analysis, vessel size was positively correlated with body surface area (P[trend] < .01), body mass index (P[trend] = .004), height (P[trend] = .001), and weight (P[trend] = .001). After controlling for differences in age and body size, sex remained an important predictor of coronary size. Within each quartile of each body-size measure, mid-LAD diameter in men was greater than that in women (mean difference [range], 0.14 to 0.23 mm).
Conclusions:
Small mid-LAD diameter is associated with substantially increased risk of in-hospital mortality with CABG. Although body size is correlated with mid-LAD diameter, women have smaller coronary arteries than men after controlling for differences in body size. These findings further support the hypothesis that smaller coronary arteries explain higher perioperative mortality with CABG in women and smaller people.
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