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Referral pattern and outcome in men and women undergoing coronary artery bypass surgery--a critical review
K M Hussain1, A Kogan, A Q Estrada
1Department of Cardiology, St. Francis Hospital of Evanston, Illinois 60202, USA.
Insights
Women undergoing coronary artery bypass surgery have similar survival rates to men when factors like age and health are considered. However, women may experience more complications and different recovery patterns post-surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Health Outcomes Research
Background:
- Women with coronary artery disease (CAD) are less frequently referred for coronary artery bypass surgery (CABS) compared to men.
- Historically, higher in-hospital mortality rates for women undergoing CABS have been reported.
Purpose of the Study:
- To investigate whether female gender is an independent predictor of operative mortality in CABS.
- To compare immediate and late survival rates between men and women after CABS.
- To identify differences in complications and recovery experiences between genders post-CABS.
Main Methods:
- Analysis of clinical data comparing outcomes between male and female patients undergoing CABS.
- Statistical adjustment for confounding variables including age, referral status, angina classification, comorbidities, and coronary anatomy.
- Assessment of perioperative and long-term outcomes, including mortality, morbidity, and graft patency.
Main Results:
- When adjusted for clinical factors, female gender is not a significant predictor of operative mortality.
- Women experience comparable immediate and late survival rates to men post-CABS.
- Women show higher rates of recurrent angina, perioperative myocardial infarction, heart failure, incomplete revascularization, and graft reocclusion, with differing recovery experiences.
Conclusions:
- The decision for CABS in women should be individualized, based on clinical risk factors and coronary anatomy, not gender.
- CABS should not be withheld from appropriate female candidates due to concerns about success rates.
- While survival is comparable, closer monitoring for complications and tailored recovery support may be beneficial for women post-CABS.
Abstract:
Women with coronary artery disease are less likely to undergo coronary artery bypass surgery, and this may represent a potential referral bias in favor of men. A higher in-hospital mortality rate in women compared with men has been reported earlier. Accumulating evidence currently suggests, however, that variables other than gender, such as advanced age, late referral, angina classification, diabetes mellitus, concurrent medical conditions, the number of diseased vessels, the caliber of coronary arteries, and the decreased body surface area in women may have accounted for this difference. In fact, when these variables are taken into account, female gender is no longer a statistically significant predictor of operative mortality. Women appear to have comparable immediate and late survival rates. Recurrent angina, perioperative myocardial infarction, congestive heart failure, incomplete revascularization, and early and late graft reocclusion following surgery are, however, more prevalent in women. Men and women show differences in recovery experiences after discharge following bypass surgery. When coronary bypass surgery is offered to women, the decision should be individualized, based on the patients' perioperative baseline clinical risk factors and coronary anatomy. Coronary artery bypass surgery should not be withheld in women who are considered to be appropriate candidates for fear of a reduced success rate.