Sex differences in hospital mortality after coronary artery bypass surgery: evidence for a higher mortality in younger women

Vaccarino, Viola; Abramson, Jerome L.; Veledar, Emir; Weintraub, W.S.

doi:10.1016/s1062-1458(02)00832-2

Cited by 97 publications

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“…32,33 When body surface area, a proxy measure for coronary artery size, was controlled for in studies of hospital mortality, it explained the higher operative mortality among women in some studies 9,34 but not in others. 24,35 In our study, sex-related outcome differences persisted after adjustment for body surface area. However, it should be noted that the latter is only an approximation of coronary artery size, and women have smaller coronary arteries than men independent of body size.…”

Section: Why Do Women Fare Worse Than Men After Cabg?mentioning

confidence: 43%

Sex differences in health status after coronary artery bypass surgery

Vaccarino¹,

Lin²,

Kasl³

2004

ACC Current Journal Review

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Background-Although previous studies have shown functional improvements in patients who undergo coronary artery bypass graft (CABG) surgery, data are conflicting on whether the gains achieved by women are similar to or less than those achieved by men. Methods and Results-We compared physical and psychological functional gains and readmission rates between 777 men and 295 women who underwent first CABG consecutively between February 1999 and February 2001. Physical function and mental health were measured by means of the Short Form 36-Item Health Survey (SF-36). At 6 months, both men and women showed, on average, a significant improvement in physical function and mental health, but men improved significantly more than women. After adjustment for baseline characteristics, the mean score improvement in women was half that of men for physical function (7.3 versus 14.0, Pϭ0.0002) and 25% less than that of men for mental health (Ϫ3.0 versus 8.9, Pϭ0.026). The absolute rates of adverse outcomes, such as hospital readmission, worsening functional status, and worsening mental health, were significantly higher in women (32.6%, 25.7%, and 17.5%, respectively) than in men (21.2%, 11.1%, and 12.6%, respectively) and remained significantly different in multivariable analysis. Conclusions-CABG surgery is associated with lower functional gains and higher readmission rates in women compared with men 6 months after operation.

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Section: Why Do Women Fare Worse Than Men After Cabg?mentioning

confidence: 43%

Sex differences in health status after coronary artery bypass surgery

Vaccarino¹,

Lin²,

Kasl³

2004

ACC Current Journal Review

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“…On average, in-hospital mortality is 2 times higher in women in comparison with men, and stratification according to age reveals a more pronounced difference in younger women. 4,8 In addition, women have a higher incidence of periprocedural morbid events, such as stroke and bleeding, in comparison with men. 2,8 Despite similar procedural success rates, albeit higher vascular and bleeding complication rates in women, in-hospital mortality also remains higher in women than in men undergoing contemporary PCI, although the magnitude of the sex difference in unadjusted mortality has decreased considerably.…”

Section: In-hospital Mortalitymentioning

confidence: 99%

“…Despite a lower prevalence of previous myocardial infarction and left ventricular dysfunction than men, they have more congestive heart failure. [2][3][4][5][6] Yet, the extent of epicardial coronary artery disease, as measured by angiography, is similar (or less) in women in comparison to men, a finding that refutes the hypothesis that women are referred for coronary angiography less often or later in the course of their disease than men. Although the reasons for this sex difference in the degree of symptoms and risk factors in relation to the extent of angiographic disease are unclear, microvascular dysfunction, abnormal vasomotor tone, and endothelial dysfunction in women are often implicated.…”

Section: Clinical Angiographic and Procedural Characteristicsmentioning

confidence: 99%

“…In multiple randomized trials and registries, women have been reported to have a higher incidence of congestive heart failure despite better left ventricular function (with fewer previous infarctions) than men. [2][3][4][5][6]9 This is best illustrated in the Bypass Angioplasty Revascularization Investigation (BARI), in which, despite the similar incidence of in-hospital death and myocardial infarction, there was a significantly higher incidence of congestive heart failure or pulmonary edema after both CABG and PCI in women compared with men. 5 For patients undergoing CABG, congestive heart failure has been shown to account for the excess mortality in women, 2 and congestive heart failure is an independent predictor of mortality in both women and men in BARI and other revascularization studies.…”

Section: In-hospital Mortalitymentioning

confidence: 99%

“…Differences between women and men in the extent of epicardial coronary artery disease in relation to risk factors and the degree of stable and unstable angina, in the relationship between congestive heart failure and left ventricular systolic function, and recently, in the higher in-hospital mortality after revascularization in younger but not older women in comparison to men have been noted. 4 It has been suggested that improvements in procedural technology and technique, particularly the increasing performance of off-pump procedures and use of heparin bonded circuits, and the widespread use of stents and adjunctive pharmacotherapy in patients undergoing both coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) would improve outcomes in women. Therefore, it is timely to review the current status and issues concerning coronary revascularization in women.…”

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confidence: 99%

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Coronary Revascularization in Women in 2003

Jacobs

2003

Circulation

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During the past 3 decades, numerous and remarkably consistent studies have reported sex differences in the epidemiology, prevention, diagnosis, and clinical manifestations of coronary artery disease, 1 and, especially noteworthy, in the sex differences in patients undergoing coronary revascularization, where a disturbingly higher mortality rate has been noted in women. 2,3 In fact, multiple paradoxes have been observed. Differences between women and men in the extent of epicardial coronary artery disease in relation to risk factors and the degree of stable and unstable angina, in the relationship between congestive heart failure and left ventricular systolic function, and recently, in the higher in-hospital mortality after revascularization in younger but not older women in comparison to men have been noted. 4 It has been suggested that improvements in procedural technology and technique, particularly the increasing performance of off-pump procedures and use of heparin bonded circuits, and the widespread use of stents and adjunctive pharmacotherapy in patients undergoing both coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) would improve outcomes in women. Therefore, it is timely to review the current status and issues concerning coronary revascularization in women. Clinical, Angiographic, and Procedural CharacteristicsVirtually all single-center and large-scale multicenter registries have reported that in comparison to men, women undergoing CABG or PCI have more comorbid disease, are older, are smaller in size, and have a higher prevalence of hypertension, diabetes mellitus, hypercholesterolemia, peripheral vascular disease, and unstable angina, as well as more severe (Canadian Cardiovascular Society class III-IV) angina. Despite a lower prevalence of previous myocardial infarction and left ventricular dysfunction than men, they have more congestive heart failure. [2][3][4][5][6] Yet, the extent of epicardial coronary artery disease, as measured by angiography, is similar (or less) in women in comparison to men, a finding that refutes the hypothesis that women are referred for coronary angiography less often or later in the course of their disease than men. Although the reasons for this sex difference in the degree of symptoms and risk factors in relation to the extent of angiographic disease are unclear, microvascular dysfunction, abnormal vasomotor tone, and endothelial dysfunction in women are often implicated. Despite smaller vessel size in women, coronary lesion morphology and distribution is similar to that in men, except that women tend to have more ostial lesions. 5 For patients undergoing CABG, the increased incidence of incomplete revascularization in women is no longer apparent, although women receive fewer internal mammary artery conduits than men, 2,5 a difference unexplained by unstable symptoms or the prevalence of diabetes. In patients undergoing contemporary PCI, stent usage is similar in women and men after adjusting for vessel size. 6 In comparison with...

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Acute Coronary Syndromes

Hochman¹,

Tamis‐Holland²

2002

JAMA

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12. Acute Coronary SyndromesDoes Sex Matter?Judith S. Hochman, MD Jacqueline E. Tamis-Holland, MD I N 1960, THE AMERICAN HEART ASSOCIATION (AHA) SPONsored a conference in Portland, Ore about women and cardiovascular disease (CVD) entitled "How I Can Help My Husband Cope With Heart Disease." Today, recognizing that cardiovascular disease is the leading cause of death for women older than 50 years, the AHA now routinely holds conferences about heart disease in women, and the National Heart, Lung, and Blood Institute and the National Institutes of Health Office of Research on Women's Health devote substantial attention to this area. Do women and men respond to cardiovascular therapies in the same way? For the most part, yes. However, biological differences, down to the cellular level, might account for different therapeutic effects and adverse responses.1 For example, women are at greater risk from drugs that prolong the QT interval, including antiarrhythmics, antibiotics, and antihistamines.2 Similarly, in patients with congestive heart failure, a recent study suggested that digitalis use was associated with excess risk of death in women but not in men. 3 In this issue of THE JOURNAL, Glaser and colleagues 4 report an important observation from the TACTICS-TIMI 18 (Treat angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy-Thrombolysis In Myocardial Infarction 18) study-that an early invasive strategy in women with non-ST-segment elevation acute coronary syndrome (ACS) results in similar benefits to men so treated. This observation stands in contrast to the findings of 2 previously reported studies testing an invasive strategy for non-ST-segment elevation ACS, the FRISC II (Fragmin and Revascularization during Instability in Coronary artery disease II) 5 and RITA-3 (Randomized Intervention Trial of unstable Angina 3) studies. 6 These studies reported benefit for men and a suggestion of harm for women. Why the different results?In TACTICS-TIMI 18, 2220 patients with non-STsegment elevation ACS, including myocardial infarction (MI) and unstable angina, were randomly assigned to receive either an invasive strategy (routine coronary angiography, percutaneous coronary intervention [PCI], or coronary artery bypass graft [CABG] surgery) or a conservative strategy (medical therapy, with revascularization reserved for patients with spontaneous or inducible ischemia). One third of the participants were women; they were older than the men and had higher rates of hypertension and diabetes, and lower rates of prior MI and revascularization. Women had higher rates of no significant coronary artery stenoses compared with men, and less often had elevated levels of cardiac troponin T. These findings are consistent with the results from other trials and registries of patients with ACS. Earlier studies have also reported more nonspecific electrocardiographic changes and atypical symptoms in women with ACS. 7,8 Women more often have coronary spasm with minimal coronary stenoses, as well as card...

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Sex differences in hospital mortality after coronary artery bypass surgery: evidence for a higher mortality in younger women

Cited by 97 publications

References 0 publications

Sex differences in health status after coronary artery bypass surgery

Sex differences in health status after coronary artery bypass surgery

Coronary Revascularization in Women in 2003

Acute Coronary Syndromes

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