Influence of Sex and Race or Ethnicity on Major Adverse Cardiovascular Outcomes Following Coronary Artery Bypass Surgery in a Large Integrated Health Care System

We aimed to evaluate the influence of sex and race or ethnicity on major adverse cardiovascular events (MACEs) following coronary artery bypass grafting (CABG). This was a retrospective study of Kaiser Permanente Northern California members who underwent CABG from 2008 to 2019, evaluating odds of MACEs (myocardial infarction, stroke, serial percutaneous intervention, repeat CABG, death) at 30 days, 1 year, and up to 12 years follow-up using multivariable logistic and proportional hazards regression analyses. We adjusted for demographic, clinical/surgical, and socioeconomic characteristics. Cohort included n=7405 with mean age 65.2 years. There were n=6082 men and n=1323 women with 2179 (35.8%) and 639 (48.3%) MACEs, respectively. Older age, higher glycated hemoglobin, diabetes, end-stage renal disease, lower hemoglobin, higher creatinine, smoking, lack of cardiopulmonary bypass, and use of nonarterial graft were significant predictors of long-term MACEs. Female sex was associated with an increased odds of MACE at 30 days (odds ratio, 1.62 [95% CI, 1.19-2.21]) and 1 year (hazard ratio, 1.24 [95% CI, 1.02-1.51]). Female, Black, and Other (Native American, multiethnic or missing) race or ethnicity groups had the greatest incidence of MACEs at up to 12 years follow-up post CABG, with differences largely driven by increased risk factor burden. Black and Other race or ethnicity were not significantly associated with long-term CABG risk in multivariable modeling. Further understanding is required to improve upstream preventive efforts.