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Gender and coronary artery bypass grafting in cardiogenic shock

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Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Purpose

Bypass surgery in patients undergoing cardiogenic shock caused by acute coronary syndrome is one of the most urgent and often performed cardiac operations. It remains unclear if patients gender independently influences the outcome. Literature reveals that females and males primarily differ from each other with regard to many important preoperative characteristics. Our objective was to compare the outcome and postoperative courses of both genders, using matched samples, eliminating these preoperative differences.

Methods

Between 2007 and 2015, 491 patients in cardiogenic shock underwent urgent bypass surgery in our institution. To assess the impact of gender on outcomes, we performed a propensity score matching to create two groups [males and females] which were matched for age, severity of shock, coronary artery disease morphology, and other comorbidities. Two groups were created: (1) 103 female and (2) 103 male patients. We analyzed the outcomes, complications and potential mortality predictors.

Results

Most of the patients had three-vessel disease (70.1%, n = 344) with proximal left anterior descending lesion (88%, n = 432). Our study showed no differences between female and male patients regarding choice of conduits, number of anastomosed vessels, and outcome. Acute kidney injury (AKI) occurred significantly more often in female patients and pericardial tamponade in their male counterparts. There were no differences regarding other major complications.

Conclusion

Gender does not appear to influence long-term outcomes in the study sample. Female gender is an independent risk factor for postoperative AKI. Other complications occurred with comparable rates in both genders. Exertion tolerance in the follow-up period was similar between genders.

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References

  1. van Diepen S, Katz JN, Albert NM, et al. Contemporary management of cardiogenic shock: a scientific statement from the American Heart Association. Circulation. 2017;136:e232–68.

    Article  Google Scholar 

  2. Thiele H, Ohman EM, Desch S, Eitel I, de Waha S. Management of cardiogenic shock. Eur Heart J. 2015;36:1223–30.

    Article  Google Scholar 

  3. Tharmaratnam D, Nolan J, Jain A. Management of cardiogenic shock complicating acute coronary syndromes. Heart. 2013;99:1614–23.

    Article  Google Scholar 

  4. Moosvi AR, Gheorghiade M, Goldstein S, Khaja F. Management of cardiogenic shock complicating acute myocardial infarction: The Henry Ford Hospital experience and review of the literature. Henry Ford Hosp Med J. 1991;39:240–4.

    CAS  PubMed  Google Scholar 

  5. Wong SC, Sleeper LA, Monrad ES, et al. Absence of gender differences in clinical outcomes in patients with cardiogenic shock complicating acute myocardial infarction. A report from the SHOCK Trial Registry. J Am Coll Cardiol. 2001;38:1395–401.

    Article  CAS  Google Scholar 

  6. Karlson BW, Herlitz J, Hartford M. Prognosis in myocardial infarction in relation to gender. Am Heart J. 1994;128:477–83.

    Article  CAS  Google Scholar 

  7. Kassambara A, Kosinski M. Survminer: drawing survival curves using 'ggplot2'. R package version 0.4.2. 2018. https://cran.r-project.org/package=survminer.

  8. R-Development-Core-Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. 2008. http://www.r-project.org/.

  9. Kurmani S, Squire I. Acute heart failure: definition, classification and epidemiology. Curr Heart Fail Rep. 2017;14:385–92.

    Article  CAS  Google Scholar 

  10. Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;64:e139–228.

    Article  Google Scholar 

  11. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis. Quality Initiative (ADQI) Group. Crit Care. 2004;8:R204–12.

    Article  Google Scholar 

  12. Leviner DB, Torregrossa G, Puskas JD. Incomplete revascularization: what the surgeon needs to know. Ann Cardiothorac Surg. 2018;7:463–9.

    Article  Google Scholar 

  13. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth Universal Definition of Myocardial Infarction (2018). Circulation. 2018;138:e618–e651.

  14. Watson TJ, Ong PJL, Tcheng JE, editors. Primary angioplasty: a practical guide. Chapter 16. Role of coronary artery bypass surgery in acute myocardial infarction. Singapore: Springer. 2018.

  15. Katircibasi MT, Kocum HT, Baltali M, et al. Effect of female gender on the outcome of coronary artery bypass surgery for left main coronary artery disease. Anadolu Kardiyol Derg. 2007;7:134–9.

    PubMed  Google Scholar 

  16. Swaminathan RV, Feldman DN, Pashun RA, et al. Gender differences in in-hospital outcomes after coronary artery bypass grafting. Am J Cardiol. 2016;118:362–8.

    Article  Google Scholar 

  17. Sadowski M, Gutkowski W, Raczynski G, Gierlotka M, Polonski L. Mortality in cardiogenic shock complicating acute myocardial infarction due to left main coronary artery disease: does gender matter? Przegl Lek. 2014;71:117–21.

    PubMed  Google Scholar 

  18. Fengler K, Fuernau G, Desch S, et al. Gender differences in patients with cardiogenic shock complicating myocardial infarction: a substudy of the IABP-SHOCK II-trial. Clin Res Cardiol. 2015;104:71–8.

    Article  Google Scholar 

  19. Weitzman LB, Tinker WP, Kronzon I, Cohen ML, Glassman E, Spencer FC. The incidence and natural history of pericardial effusion after cardiac surgery--an echocardiographic study. Circulation. 1984;69:506–11.

    Article  CAS  Google Scholar 

  20. Assali AR, Moustapha A, Sdringola S, et al. Acute coronary syndrome may occur with in-stent restenosis and is associated with adverse outcomes (the PRESTO trial). Am J Cardiol. 2006;98:729–33.

    Article  Google Scholar 

  21. Neugarten J, Sandilya S, Singh B, Golestaneh L. Sex and the Risk of AKI following cardio-thoracic surgery: A meta-analysis. Clin J Am Soc Nephrol. 2016;11:2113–22.

    Article  Google Scholar 

  22. Ranucci M, Pavesi M, Mazza E, et al. Risk factors for renal dysfunction after coronary surgery: the role of cardiopulmonary bypass technique. Perfusion. 1994;9:319–26.

    Article  CAS  Google Scholar 

  23. Ng RR, Chew ST, Liu W, Shen L, Ti LK. Identification of modifiable risk factors for acute kidney injury after coronary artery bypass graft surgery in an Asian population. J Thorac Cardiovasc Surg. 2014;147:1356–61.

    Article  Google Scholar 

  24. Mehta RH, Castelvecchio S, Ballotta A, Frigiola A, Bossone E, Ranucci M. Association of gender and lowest hematocrit on cardiopulmonary bypass with acute kidney injury and operative mortality in patients undergoing cardiac surgery. Ann Thorac Surg. 2013;96:133–40.

    Article  Google Scholar 

  25. Chikwe J, Lee T, Itagaki S, Adams DH, Egorova NN. Long-term outcomes after off-pump versus on-pump coronary artery bypass grafting by experienced surgeons. J Am Coll Cardiol. 2018;72:1478–86.

    Article  Google Scholar 

  26. Gershlick AH, Kandzari DE, Banning A, et al. Outcomes after left main percutaneous coronary intervention versus coronary artery bypass grafting according to lesion site: results from the EXCEL trial. JACC Cardiovasc Interv. 2018;11:1224–33.

    Article  Google Scholar 

  27. Marceau A, Samson J, Laflamme N, Rinfret S. Short and long-term mortality after STEMI versus Non-STEMI: A systematic review and meta-analysis. J Am Coll Cardiol. 2013;61:S8–S14.

    Article  Google Scholar 

  28. Ren L, Ye H, Wang P, Cui Y, Cao S, Lv S. Comparison of long-term mortality of acute ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndrome patients after percutaneous coronary intervention. Int J Clin Exp Med. 2014;7:5588–92.

    PubMed  PubMed Central  Google Scholar 

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Funding

This work was not financially supported.

Author information

Authors and Affiliations

  1. Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Marcin P. Szczechowicz, Sabreen Mkalaluh, Saeed Torabi, Matthias Karck & Alexander Weymann

  2. Essen Huttrop Heart Center, Herwarthstrasse100, 45138, Essen, Germany

    Jerry Easo

Authors
  1. Marcin P. Szczechowicz
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  2. Sabreen Mkalaluh
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  3. Saeed Torabi
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  4. Jerry Easo
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  5. Matthias Karck
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  6. Alexander Weymann
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Corresponding author

Correspondence to Marcin P. Szczechowicz.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

Our study was approved by the local Ethics Committee of the Heidelberg University, Germany. Number of the approval: S-570/2016. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

Ethics statement regarding human and animal rights

The study was conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national). This article does not contain any studies with animal subjects performed by the any of the authors.

Informed consent

The consent for the follow-up is a routine at admission in our clinic. The consent for processing of retrospectively collected clinical data and for publication of the results is not required because the personal data were anonymized, and the article does not include images or data that may identify the person.

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Szczechowicz, M.P., Mkalaluh, S., Torabi, S. et al. Gender and coronary artery bypass grafting in cardiogenic shock. Indian J Thorac Cardiovasc Surg 36, 580–590 (2020). https://doi.org/10.1007/s12055-020-00982-5

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  • DOI: https://doi.org/10.1007/s12055-020-00982-5

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