Coronary Artery Disease
Effect of Gender and Race on Operative Mortality After Isolated Coronary Artery Bypass Grafting

https://doi.org/10.1016/j.amjcard.2014.12.010Get rights and content

Studies examining outcomes after coronary artery bypass grafting (CABG) by gender and/or race have shown conflicting results. It remains to be determined if, or how, gender and race are independent risk factors for CABG operative mortality. Using all consecutive patients who underwent isolated CABG at Baylor University Medical Center in Dallas, Texas, from January 2004 to October 2011, the risk-adjusted associations between gender and race, respectively, and operative mortality were estimated using a generalized propensity approach, accounting for recognized Society of Thoracic Surgeons risk factors for mortality. Women were nearly 2 times more likely to die during or within 30 days of the operation than men (odds ratio 1.96, 95% confidence interval 1.44 to 2.66, p <0.0001), while no significant mortality differences were observed among races. In conclusion, these findings suggest that women face a significantly greater risk for operative death that should be taken into account during the treatment decision-making process but that race is not associated with CABG mortality and so should not be among the factors considered.

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Methods

This retrospective cohort study included all consecutive patients who underwent isolated CABG at Baylor University Medical Center in Dallas, Texas, from January 2004 to October 2011. Patients with previous valve surgery, preoperative endocarditis, and/or ventricular assist devices were excluded. The final study cohort included 8,154 consecutive patients. Data routinely collected by Baylor University Medical Center for the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database14, 15,

Results

There were a total of 226 (2.77%) operative deaths in the cohort. Unadjusted operative mortality is listed by gender in Table 1 and by race in Table 2. Figure 1 shows the predicted propensity-adjusted probabilities for post-CABG operative mortality for gender and for race. No effect modification was found between gender, race and ethnicity, type of bypass (off-pump vs on-pump) surgery, or elective versus urgent or emergent CABG. The propensity-adjusted analysis showed strong evidence of

Discussion

In this 8-year, single-center cohort, we observed significantly higher risk-adjusted operative mortality for women compared with men but no significant differences among different races and ethnicities. With regard to gender, our results support previous findings that indicate female gender independently increases the risk for operative mortality in CABG, including a meta-analysis of nearly 1 million CABG patients that found 77% greater odds of short-term mortality for women compared to men

Disclosures

The authors have no conflicts of interest to disclose.

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This work was funded in part by the Bradley Family Endowment to the Baylor Health Care System Foundation, Dallas, Texas, The Baylor Health Care System Cardiovascular Research Committee, Dallas, Texas, and the Discovery Foundation, Dallas, Texas.

See page 617 for disclosure information.

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