Abstract
BackgroundThe main purpose of this study was to evaluate the impact of gender on outcomes after isolated coronary artery bypass grafting, in terms of 5-year rates of overall death, cardiac-related death, myocardial infarction, re-hospitalization, repeat percutaneous or surgical revascularization, stroke, new pacemaker implantation, postoperative renal failure, heart failure and need for long-term care.MethodsTwo propensity-score matched cohorts, each of 1331 patients, undergoing isolated surgical coronary revascularization at the regional public and private centers of Emilia-Romagna region (Italy) from January 1st 2003 to December 31th 2013, were used to compare long-term outcomes of male (5976 patients) versus female gender (1332 patients).ResultsIn the matched cohort, males received significantly more bypass grafts (3.0 ± 1.0 vs 2.8 ± 1.0, p = 0.001). Left internal mammary artery use and total arterial revascularization were similarly performed in both matched subgroups. Both groups reported similar cumulative rate of all-cause, cardiac-related mortality and stroke at five years. Females experienced significantly higher rate of myocardial infarction, and not significantly higher occurrence of heart failure, and need for long-term care. Males experienced significantly higher rate of cumulative re-hospitalization and higher need for pacemaker implantation. Female gender was not an independent predictor of death at long-term follow-up.ConclusionsWomen are more likely to be readmitted with myocardial infarction and congestive heart failure after CABG but experience survival similar to that observed in men. Female gender was not an independent risk factor for mortality. Prevention of new occurrence of postoperative myocardial infarction and enhancement of complete coronary revascularization should be future endpoints.
Highlights
The main purpose of this study was to evaluate the impact of gender on outcomes after isolated coronary artery bypass grafting, in terms of 5-year rates of overall death, cardiac-related death, myocardial infarction, re-hospitalization, repeat percutaneous or surgical revascularization, stroke, new pacemaker implantation, postoperative renal failure, heart failure and need for long-term care
A constant reduction in the number of overall isolated elective coronary artery bypass grafting (CABG) was observed in our registry between 2003 and 2013, this reduction occurred mainly in the male patients subgroup (Fig. 1)
There are operative disparities in the number of bypass grafts that women receive, which results in a lower percentage of complete revascularization and which could partially explain these differences in morbidity
Summary
The main purpose of this study was to evaluate the impact of gender on outcomes after isolated coronary artery bypass grafting, in terms of 5-year rates of overall death, cardiac-related death, myocardial infarction, re-hospitalization, repeat percutaneous or surgical revascularization, stroke, new pacemaker implantation, postoperative renal failure, heart failure and need for long-term care. Few studies investigated a relatively large study population [1, 2, 5, 6, 9, 13, 15, 18] and, with the exception of a few [3,4,5, 8, 9, 18], most of these studies reported only perioperative or intermediate follow-up outcomes Another limitation of the previous literature is that it frequently evaluated only the mortality as primary endpoint [6, 8, 10, 11, 13, 15, 17]. There has been less research into long-term differences of other morbidity endpoints and nonfatal events between males and females after isolated CABG [3,4,5, 9, 18]
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