Key result
Female sex shows no association with higher operative mortality versus male sex in isolated CABG.
Why the study?
Several studies reported higher mortality for women undergoing isolated CABG, but it remains unclear if female sex is an independent risk factor for early mortality.
Does female sex increase the risk of early mortality in patients undergoing isolated coronary artery bypass graft?
Cohort (n=3,756)
No
Does female sex increase the risk of early mortality in patients undergoing isolated coronary artery bypass graft?
Absolute Event Rate: 3.8% vs 2.7%
p-value: p=0.20
Female sex is not an independent risk factor for early mortality after isolated CABG, though comorbidities like diabetes, renal dysfunction, and obesity confer higher risk in women than men.
May not indicate excess operative mortality risk for women after isolated CABG; leaves open need for validation in prospective cohorts.
AIMS: Despite several studies reporting a higher mortality rate for women undergoing isolated coronary artery bypass graft (CABG) surgery, this issue has not been completely clarified. The aim of the current study was to determine if sex differences in CABG surgery affect adjusted operative results and operative mortality. METHODS: Between January 2005 and December 2012, 3756 consecutive patients (3009 men and 747 women) underwent isolated CABG at our institution. Women presented with older age, smaller BSA and higher rate of preoperative comorbidities. The propensity score methodology was used to obtain risk-adjusted outcome comparisons between the two groups. RESULTS: The distribution of preoperative variables among matched pairs (553 patients in both groups) was, on average, equal. Propensity-matched women received a similar number of distal anastomoses (P = 0.56), had similar rate of left internal thoracic artery (LITA) graft (P = 0.73) and comparable extracorporeal circulation (P = 0.61) and aortic cross-clamp (P = 0.39) time as men. Postoperative complications were comparable in the two study groups with the exception of postoperative transfusion rate which was significantly higher in women (P = 0.01). However, operative mortality (3.8 vs. 2.7%; P = 0.20), perioperative acute myocardial infarction (P = 0.50) and stroke (P = 0.75) were not significantly different between the two groups. Interestingly, after adjustment for the other baseline characteristics, female patients with diabetes (P = 0.03), preoperative renal dysfunction (P = 0.07) and obesity (P = 0.07) exhibited a greater operative mortality rate compared with men with the same comorbidities. CONCLUSION: After adjustment for preoperative variables, female sex seems not to be an independent risk factor for early mortality in isolated CABG surgery. However, renal impairment, diabetes and obesity seem to play an important role in the operative risk profile of women undergoing isolated CABG.
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Garatti et al. (2018) conducted a cohort in Isolated coronary artery bypass graft (CABG) (n=3,756). Female sex vs. Male sex was evaluated on Operative mortality (p=0.20). In propensity-matched patients undergoing isolated CABG, female sex was not associated with a significantly higher risk of operative mortality compared to male sex (3.8% vs 2.7%; P=0.20).
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