Female Gender is not a Risk Factor for Early Mortality after Coronary Artery Bypass Grafting

Gender Differences in Survival after Coronary Artery Bypass Grafting-13-Year Results from KROK Registry

The influence of gender on both early and long-term outcomes of coronary artery bypass grafting (CABG) is not clearly defined. Objectives: This study aimed to assess the impact of gender on early and long-term mortality after CABG using data from the KROK Registry. Methods: All 133,973 adult patients who underwent CABG in Poland between 1 January 2009 and 31 December 2019 were included in the Polish National Registry of Cardiac Surgical Procedures (KROK Registry). The study enrolled 90,541 patients: 68,401 men (75.55%) and 22,140 women (24.45%) who met the inclusion criteria. Then, 30-day mortality, 1-year mortality, and long-term mortality rates were compared. Results: Advanced age, higher Canadian Cardiovascular Society (CCS) and New York Heart Association (NYHA) grade, diabetes, hypercholesterolemia, arterial hypertension, body mass index BMI > 35 kg/m2, and renal failure, before the propensity matching, were more frequently observed in women. Women more frequently underwent urgent surgery, including single and double graft surgery, and off-pump CABG (OPCAB) (p < 0.001). In propensity-matched groups, early mortality (30 days) was significantly higher in women (3.4% versus 2.8%, p < 0.001). The annual mortality remained higher in this group (6.6% versus 6.0%, p = 0.025). However, long-term mortality differed significantly between the groups and was higher in the male group (33.0% men versus 28.8% women, p < 0.001). Conclusions: There are no apparent differences in long-term mortality between the two sexes in the entire population. In propensity-matched patients, early mortality was lower for men, but the long-term survival was found to be better in women.

Female gender does not have any significant impact on the early postoperative outcomes after coronary artery bypass grafting: a propensity-matched analysis

Purpose

Coronary artery bypass grafting (CABG) is the most common cardiac surgical procedure performed in India. There are fundamental differences between males and females in the incidence and responses of the body to various diseases. These differences are noticeable, more so in conditions relating to cardiovascular health, particularly coronary artery disease (CAD). This study aims to assess the gender differences in the early postoperative outcomes following CABG.

Methods

Between April 1999 through February 2018, 13,415 patients underwent isolated CABG in our practice. Propensity score matching was performed to yield 1825 well-matched pairs in each gender. These groups were compared in terms of various early postoperative outcomes.

Results

There were no significant differences between females and males in terms of early postoperative composite outcomes (4.2% vs. 5.2%) (odds ratio (OR) 0.82; 95% confidence interval (CI) 0.60-1.12, p = 0.213) of 30-day mortality, non-fatal myocardial infarction (MI), non-fatal cerebrovascular accidents (CVA), and need for renal replacement therapy (RRT), 30-day mortality (0.7% vs. 0.7%) (OR 1.11; 95%CI 0.50-2.45, p = 0.796), MI (2.7% vs. 3.1%) (OR 0.93; 95%CI 0.63-1.37, p = 0.708), CVA (0.4% vs. 0.8%) (OR 0.46; 95%CI 0.19-1.14, p = 0.096), and need for RRT (0.7% vs. 0.7%) (OR 0.88; 95%CI 0.40-1.93, p = 0.753).

Conclusion

Females have similar early postoperative outcomes compared to males in terms of composite outcomes of 30-day mortality, non-fatal MI, non-fatal CVA, and RRT among patients undergoing CABG. The outcomes are also similar when individually assessed. The off-pump technique has no additional benefit compared to the on-pump technique in females undergoing CABG.

Differences in gender and outcomes following isolated coronary artery bypass graft (CABG) surgery

BACKGROUND

Gender impacts pre-, intra-, and postoperative parameters and outcomes following coronary artery bypass graft (CABG) with conflicting results. This study aimed to identify differences in preoperative, intraoperative, and postoperative parameters. It also seeks to compare the postoperative complications and mortality between two genders who had CABG surgery.

METHOD

This prospective observational study included patients who had isolated CABG and were divided based on gender. Demographic information, underlying comorbidities, drug history, clinical and laboratory data at the time of referral, operative characteristics, postoperative variables, and mortality outcomes were tracked during hospitalization and six months after discharge.

RESULTS

Three hundred twenty patients were enrolled in the study during its duration. 71% were male. Women were older (62.40±9.03 vs. 59.99±9.81 years, p= 0.011) and had more dyslipidemia (p=0.003), hypertension (p=0.000), and diabetes (p=0.001), whereas men admitted with more myocardial infarction (MI) (p=0.011) and had lower Ejection fraction (EF) (p=0.001). They also had lower EF post-surgery (p <0.001) and six months after discharge (p = 0.006). However, the number of vessels involved was not different between genders (p=0.589), but the number of grafts was higher in men (p=0.008).There was no statistically significant difference in overall mortality rates between the two groups (4.42% and 6.38% in men and women, respectively, p= 0.464).

CONCLUSIONS

The women had more underlying comorbidities than men. Furthermore, there were some differences in the intra-operative parameters and postoperative complications between the two genders, but there was no difference in postoperative mortality in our setting.

Homelessness and Race are Mortality Predictors in US Veterans Undergoing CABG

Coronary artery disease requiring surgical revascularization is prevalent in United States Veterans. We aimed to investigate preoperative predictors of 30-day mortality following coronary artery bypass grafting (CABG) in the Veteran population. The Veterans Affairs Surgical Quality Improvement (VASQIP) national database was queried for isolated CABG cases between 2008 and 2018. The primary outcome was 30-day mortality. A multivariable logistic regression was performed to assess for independent predictors of the primary outcome. A P-value of <0.05 was considered statistically significant. A total of 32,711 patients were included. The 30-day mortality rate was 1.37%. Multivariable analysis identified the following predictors of 30-day mortality: African-American race (OR 1.46, 95% CI 1.09-1.96); homelessness (OR 6.49, 95% CI 3.39-12.45); female sex (OR 2.15, 95% CI 1.08-4.30); preoperative myocardial infarction within 7 days (OR 1.49, 95% CI 1.06-2.10) or more than 7 days before CABG (OR 1.34, 95% CI 1.04-1.72); partially/fully dependent functional status (OR 1.44, 95% CI 1.07-1.93); chronic obstructive pulmonary disease (OR 1.54, 95% CI 1.24-1.92); mild (OR 1.48, 95% CI 1.04-2.11) and severe aortic stenosis (OR 2.06, 95% CI 1.37-3.09); moderate (OR 1.88, 95% CI 1.31-2.72), or severe (OR 2.99, 95% CI 1.71-5.22) mitral regurgitation; cardiomegaly (OR 1.73, 95% CI 1.35-2.22); NYHA Class III/IV heart failure (OR 2.05, 95% CI 1.10-3.83); and urgent/emergent operation (OR 1.42, 95% CI 1.08-1.87). The 30-day mortality rate in US Veterans undergoing isolated CABG between 2008 and 2018 was 1.37%. In addition to established clinical factors, African-American race and homelessness were independent demographic predictors of 30-day mortality.

Patient and hospital factors associated with 30-day readmissions after coronary artery bypass graft (CABG) surgery: a systematic review and meta-analysis

BACKGROUND

Readmission after coronary artery bypass graft (CABG) surgery is associated with adverse outcomes and significant healthcare costs, and 30-day readmission rate is considered as a key indicator of the quality of care. This study aims to: quantify rates of readmission within 30 days of CABG surgery; explore the causes of readmissions; and investigate how patient- and hospital-level factors influence readmission.

METHODS

We conducted systematic searches (until June 2020) of PubMed and Embase databases to retrieve observational studies that investigated readmission after CABG. Random effect meta-analysis was used to estimate rates and predictors of 30-day post-CABG readmission.

RESULTS

In total, 53 studies meeting inclusion criteria were identified, including 8,937,457 CABG patients. The pooled 30-day readmission rate was 12.9% (95% CI: 11.3-14.4%). The most frequently reported underlying causes of 30-day readmissions were infection and sepsis (range: 6.9-28.6%), cardiac arrythmia (4.5-26.7%), congestive heart failure (5.8-15.7%), respiratory complications (1-20%) and pleural effusion (0.4-22.5%). Individual factors including age (OR per 10-year increase 1.12 [95% CI: 1.04-1.20]), female sex (OR 1.29 [1.25-1.34]), non-White race (OR 1.15 [1.10-1.21]), not having private insurance (OR 1.39 [1.27-1.51]) and various comorbidities were strongly associated with 30-day readmission rates, whereas associations with hospital factors including hospital CABG volume, surgeon CABG volume, hospital size, hospital quality and teaching status were inconsistent.

CONCLUSIONS

Nearly 1 in 8 CABG patients are readmitted within 30 days and the majority of these are readmitted for noncardiac causes. Readmission rates are strongly influenced by patients' demographic and clinical characteristics, but not by broadly defined hospital characteristics.

Gender differences in coronary artery diameters and survival results after off-pump coronary artery bypass (OPCAB) procedures

Background

Cardiovascular disease is still the leading cause of death among men and women. The gender related survival differences following off-pump surgery was the subject of the study with relation to coronary arteries diameters according to sizes of intraluminal shunts applied during surgery.

Methods

We retrospectively collected data of 2,772 patients who were referred for surgical revascularization in our department between 2010 and 2018 with mean follow up period of 76 months. Patients underwent coronary artery bypass grafting with off-pump technique (OPCAB) with intraluminal shunts application during each anastomosis.

Results

The multivariate Cox’s proportional hazards model revealed male sex as significant all-cause mortality risk factor [hazard ratio (HR) =4.62; 95% confidence interval (CI): (3.12–6.83)]. The survival proportion was significantly lower in male than female (73% vs. 94%; P<0.0001) within 130 months of follow up despite favorable results of coronary artery diameters. Mean ± standard deviation (SD) diameters of coronary arteries measured by shunts applied during off-pump revascularization were 1.81±0.28 vs. 1.7±0.26 mm (P<0.0001) for left anterior descending artery (LAD) anastomosis, 1.78±0.27 vs. 1.71±0.29 mm (P<0.0001) for circumflex artery (Cx) anastomosis and 1.77±0.28 vs. 1.72±0.31 mm (P>0.05) for right coronary artery (RCA) anastomosis in men and women subgroups, respectively.

Conclusions

Female sex is associated with better overall late survival following surgical revascularization despite smaller diameters of coronary arteries in direct measurement with the use of intraluminal shunt application.

Gender Bias in Cardiovascular Disease Prevention, Detection, and Management, with Specific Reference to Coronary Artery Disease

Even though cardiovascular disease (CVD) kills more women than men each year and remains a leading cause of death in women, it is a common misconception that women are less likely to develop CVD. Considerable sex difference exists between men and women with regard to prevention, investigations, and management of CVD. Coronary artery disease (CAD) is a major contributor to CVD morbidity and mortality and hence is specifically addressed in this article. With an explosive increase in the incidence of conventional risk factors for coronary artery disease in India, there has been an alarming increase in women's coronary events as much as men. A false sense of gender-based protection by estrogen leads to less aggressive and late prevention or management strategies that contribute to women's CAD. Metabolic syndrome (MetS) is an important contributor to future development of CAD and is also an indicator for earlier interventions for prevention. Due to physical inactivity and central obesity, MetS is more prevalent in women, especially postmenopausal. With estrogen loss, menopause marks a critical cardiovascular biological transition, with a significantly increased CVD risk in women aged >55 years. Certain female-specific risk factors, such as history of polycystic ovarian syndrome, pregnancy-induced hypertension, and gestational diabetes, also seem to play an essential role in the development of CVD in later life. Certain vascular and biological factors, such as smaller coronary vessel size, higher prevalence of small vessel disease, and lesser development of collateral flow, also play an important role. This review article is an attempt to provide important information on gender differences in CVD with specific emphasis on CAD.