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Post-CABG Risk Remains Higher for Women vs Men with No Change Over Last 10 Years
After coronary artery bypass surgery, women are still at higher risk for MI, stroke, and other adverse events than men despite years of improvement in technique and care.
Women continue to be at significantly greater risk than men for poor outcomes following coronary artery bypass grafting (CABG), according to a large retrospective cohort study published on March 1 in JAMA Surgery.
The authors, who observed trends in post-CABG adverse events between 2011 and 2020 report further that there has been no significant improvement seen in the divergence in outcomes between the sexes over the last decade.
The differences in postsurgical events that can include myocardial infarction and stroke “persist despite adjustment for differences in baseline risk factors,” wrote Mario Gaudino, MD, PhD, MSCE, professor of cardiothoracic surgery in the department of cardiothoracic surgery at Weill Cornell Medicine, and colleagues.
“On a national scale, the outcomes of coronary artery bypass grafting surgery have generally improved significantly over the past decades despite an increase in the risk profile of patients referred for surgery.” What hasn’t been well studied, the researchers add, is whether or not the “gap between women and men has been mitigated or removed” as the quality of care has advanced.
To evaluate the course of outcomes among women undergoing CABG in the past decade, Gaudino and colleagues tapped and analyzed data from 1 297 204 adults (mean age, 66 years) who underwent primary isolated coronary artery bypass from 2011 to 2020 at US hospitals that contributed to the Adult Cardiac Surgery Database of the Society of Thoracic Surgeons. Of these patients, 317 716 (24.5%) were women.
The team’s primary outcome of interest was operative mortality. Secondary outcome was the composite of operative mortality, stroke, kidney failure, reoperation, deep sternal wound infection, prolonged mechanical ventilation, and prolonged hospital stay.
FINDINGS
Gaudino et al report that women experienced higher unadjusted operative mortality (2.8% vs. 1.7%) and higher overall unadjusted incidence of the composite of operative mortality and morbidity (22.9% vs. 16.7%) compared with men (P<.001 for both). From 2011 to 2020, they found the attributable risk of female sex for operative mortality varied from 1.28 to 1.41, with no significant change over the study period (Ptrend=.38).
Attributable risk of female sex for the composite of operative mortality and morbidity during the study was 1.08 in both 2011 and 2020. Again, there was no significant change observed during the study (Ptrend=.71), according to the findings.
The authors suggest that a multifactorial approach will likely be required to reduce mortality for women after CABG, with the possibility of different indications for revascularization for men and women related to differences in the processes and pathology of coronary artery disease.
“Further investigation into the determinants of operative outcomes in women is urgently needed,” the researchers wrote.
Reference: Gaudino M, Chadow D, Rahouma M, et al. Operative outcomes of women undergoing coronary artery bypass surgery in the US, 2011 to 2020. JAMA Surg. Published online March 1, 2023. doi:10.1001/jamasurg.2022.8156.
