Hormone replacement therapy improves the survival of women undergoing coronary artery bypass grafting

Abstract

Introduction. In-hospital mortality after coronary artery bypass grafting (CABG) is higher in women than men [1Edwards F.H. Ann Thorac Surg. 1998; 66: 125-131Abstract Full Text Full Text PDF PubMed Scopus (335) Google Scholar]. Hormone replacement therapy (HRT) may reduce cardiovascular events in postmenopausal women [2Grodstein F. N Engl J Med. 1996; 335: 453-461Crossref PubMed Scopus (1284) Google Scholar, 3O’Keefe J.H. J Am Coll Cardiol. 1997; 29: 1-5Abstract Full Text Full Text PDF PubMed Scopus (135) Google Scholar]. This study investigated the relationship between HRT, mortality, and other morbidity in men and women undergoing CABG.Methods. We reviewed 4,266 consecutive CABG patients aged ≥55 years, including all emergency, redo, and concomitant operations. Univariate associations between potential predictors and outcome were assessed by χ2 followed by stepwise logistic modeling, including all significant (p = 0.10) predictors.Results. Multivariate analysis confirmed that male gender and female gender with HRT were independent predictors of decreased mortality. Mortality was 7.5% in men (n = 3,132), 11.8% in women without HRT (n = 911), and 6.3% in HRT recipients (n = 223) (p = 0.001). Analysis of a subset undergoing elective primary isolated CABG yielded similar results, with in-hospital mortality being 2.6% in men (n = 2,910), 7.1% in women without HRT (n = 637), and 2.4% in HRT recipients (n = 165) (p = 0.0003). Predictors of mortality included age, CHF, IABP, redo, emergency or concomitant procedures, duration of cardiopulmonary bypass, and female gender without HRT. There were no intergroup differences in morbid events, except that perioperative bleeding was more common in women not receiving HRT, whereas thromboembolism was less common in men (p < 0.05).Conclusions. Survival was significantly improved in postmenopausal women receiving preoperative HRT. Introduction. In-hospital mortality after coronary artery bypass grafting (CABG) is higher in women than men [1Edwards F.H. Ann Thorac Surg. 1998; 66: 125-131Abstract Full Text Full Text PDF PubMed Scopus (335) Google Scholar]. Hormone replacement therapy (HRT) may reduce cardiovascular events in postmenopausal women [2Grodstein F. N Engl J Med. 1996; 335: 453-461Crossref PubMed Scopus (1284) Google Scholar, 3O’Keefe J.H. J Am Coll Cardiol. 1997; 29: 1-5Abstract Full Text Full Text PDF PubMed Scopus (135) Google Scholar]. This study investigated the relationship between HRT, mortality, and other morbidity in men and women undergoing CABG. Methods. We reviewed 4,266 consecutive CABG patients aged ≥55 years, including all emergency, redo, and concomitant operations. Univariate associations between potential predictors and outcome were assessed by χ2 followed by stepwise logistic modeling, including all significant (p = 0.10) predictors. Results. Multivariate analysis confirmed that male gender and female gender with HRT were independent predictors of decreased mortality. Mortality was 7.5% in men (n = 3,132), 11.8% in women without HRT (n = 911), and 6.3% in HRT recipients (n = 223) (p = 0.001). Analysis of a subset undergoing elective primary isolated CABG yielded similar results, with in-hospital mortality being 2.6% in men (n = 2,910), 7.1% in women without HRT (n = 637), and 2.4% in HRT recipients (n = 165) (p = 0.0003). Predictors of mortality included age, CHF, IABP, redo, emergency or concomitant procedures, duration of cardiopulmonary bypass, and female gender without HRT. There were no intergroup differences in morbid events, except that perioperative bleeding was more common in women not receiving HRT, whereas thromboembolism was less common in men (p < 0.05). Conclusions. Survival was significantly improved in postmenopausal women receiving preoperative HRT.