The impact of race and sex on recent mortality trends after coronary artery bypass grafting

Despite declining mortality after coronary artery bypass grafting, it is unclear if Black or female patients similarly benefit. We hypothesized differences in outcomes persist and disproportionately affect Black women. We examined patients undergoing isolated coronary artery bypass grafting from July 2011 to July 2023 in a multicenter regional collaborative. Patients were stratified by race and sex: White men, White women, Black men, and Black women. Hierarchical logistic regression analyses were performed to identify trends and risk factors associated with operative mortality. Among 27,309 patients, White men, White women, Black men, and Black women made up 66.1%, 19.2%, 9.3%, and 5.4% of the cohort, respectively. Their Society of Thoracic Surgeons Predicted Risk of Mortality was 0.83%, 1.55%, 1.11%, and 1.66%, respectively ( P < .001). Mortality (1.5% vs 2.7% vs 2.5% vs 3.2%, P < .001) and major morbidity (8% vs 12% vs 14% vs 17%, P < .001) were highest in Black women. There was no reduction in mortality over time (odds ratio [OR], 1.06 95% CI, 0.95-1.2, P = .338). Compared with White men, White women (OR, 1.53, 95% CI, 1.22-1.91, P < .001), Black men (OR, 1.41, 95% CI, 1.04-1.9, P = .026), and Black women (OR, 1.8, 95% CI, 1.28-2.53, P = .001) had higher risk-adjusted odds of mortality. Society of Thoracic Surgeons Predicted Risk of Mortality (OR, 1.13, 95% CI, 1.11-1.14, P < .001), distress score (OR, 1.01 95% CI, 1.01-1.01, P = .007), log anastomosis ratio (OR, 0.775, 95% CI, 0.625-0.962, P = .021), and bypass time (OR, 1.01, 95% CI, 1.01-1.01, P < .001) were associated with mortality. Differences persist with Black women having the highest risk-adjusted odds of mortality after coronary artery bypass grafting. Reinvigorated efforts are needed in an era of plateauing mortality rates.