Excess short-term mortality in women after isolated coronary artery bypass graft surgery

Abstract

ObjectiveFemale sex is considered a risk factor for adverse outcomes following isolated coronary artery bypass graft (CABG) surgery. We assessed the association between sex and short-term mortality following isolated CABG, and estimated the ‘excess’ deaths occurring in women.MethodsShort-term mortality was investigated in 13 327 consecutive isolated CABG patients in North Texas between January 2008 and December 2012. The association between sex and CABG short-term mortality, and the excess deaths among women were assessed via a propensity-adjusted (by Society of Thoracic Surgeons-recognised risk factors) generalised estimating equations model approach.ResultsShort-term mortality was significantly higher in women than men (adjusted OR=1.39; 95% CI 1.04 to 1.86; p=0.027). This significantly greater risk translates into 35 ‘excess’ deaths among women included in this study (>10% of the total 343 deaths in the study cohort) and into 392 ‘excess’ deaths among the ∼40 000 women undergoing isolated CABG in the USA each year.ConclusionsThe higher risk associated with female sex lead to 35 ‘excess’ deaths in women in this study cohort (over 10% of the total deaths) and to 392 ‘excess’ deaths among women undergoing isolated CABG in the USA each year. Further research is needed to assess the causal mechanisms underlying this sex-related difference. Results of such work could inform the development and implementation of sex-specific treatment and management strategies to reduce women's mortality following CABG. Based on our results, if such work brought women's short-term mortality into line with men's, total short-term mortality could be reduced by up to 10%.

Short- and long-term survival after isolated coronary artery bypass grafting, the impact of gender and age

“…Some studies report that female gender, when adjusted for confounding variables, does not predict short-term survival [10,11,12]. On the contrary, a large meta-analysis by Alam et al from 2013 reported that female gender was independently associated with decreased survival [5], and other studies have showed decreased short-term survival in females when adjusting for age and other preoperative risk factors [8,13,14,15]. We found that female patients had a significantly higher median EuroSCORE I.…”

“…The impact of gender on survival after CABG has been previously reported, although with differing results [3,4,5]. Most relevant studies conclude with a gender difference in short-term survival, disfavoring female gender [3,4,5,6,7,8]. Gender is included as a variable when calculating EuroSCORE.…”

Epidemiology of new-onset atrial fibrillation following coronary artery bypass graft surgery

“…For example, while it has been shown that patients who develop secondary AF (ie, following events such as surgery, infection, acute myocardial infarction, thyrotoxicosis, acute alcohol consumption, acute pericardial disease, pulmonary embolism or other acute pulmonary disease) have similar long-term risks for stroke and mortality as patients who develop primary AF,33 the question remains open as to whether post-discharge management strategies such as arrhythmia surveillance or adherence to general AF management principles (including anticoagulation) improves outcomes for these patients. Given that >264 000 of the estimated 800 000 people worldwide undergoing CABG each year34 will develop post-CABG AF (based on the 33.1% incidence we observed), such information is urgently needed to develop effective prophylactic and management strategies.…”

Sex Differences in the Epidemiology of New-Onset In-Hospital Post–Coronary Artery Bypass Graft Surgery Atrial Fibrillation

“…The significantly greater age and higher prevalence of comorbidities such as diabetes mellitus, hypertension, and congestive heart failure among the women in our cohort is also typical of the population of CABG patients; 9,10,32,33 and the borderline statistically significant higher risk-adjusted operative mortality we observed among the women in our study cohort is consistent with the results reported by several previous studies. 12,[34][35][36][37][38] As with any observational study, we cannot rule out the possibility that unknown factors that confound the association between exposure (sex) and outcome (post-CABG AF) exist. However, the propensity-adjusted generalized estimating equations model approach developed to conduct the statistical analysis considered an extensive list of risk factors recognized by the STS in addition to other important variables, providing a rigorous adjustment for potential confounders.…”