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Circulation, Vol 88, 2104-2110, Copyright © 1993 by American Heart Association
GT O'Connor, JR Morton, MJ Diehl, EM Olmstead, LH Coffin, DG Levy, CT Maloney, SK Plume, W Nugent and DJ Malenka
BACKGROUND. A prospective study of patients undergoing coronary artery
bypass graft surgery (CABG) was conducted to examine differences in
hospital mortality by sex. Outcome data on 3055 CABG patients undergoing
operation between 1987 and 1989 were examined for differences in patient,
disease, and treatment factors. METHODS AND RESULTS. Odds ratios (OR), risk
differences, and 95% confidence intervals (CI95%) were calculated.
Mortality rates for women (7.1%) and men (3.3%) differed, the OR (women
versus men) being 2.23 (CI95%, 1.58 to 3.15). Women were older, more often
diabetic, and had more urgent or emergent surgery; adjustment yielded an OR
(women versus men) of 1.75 (CI95%, 1.17 to 2.63). Body surface area (BSA)
was associated with risk of death in both sexes (P = .007) and positively
associated with coronary artery luminal diameters. After adjustment for
BSA, sex was no longer significantly associated with mortality (OR [women
versus men] of 1.18; CI95%, 0.72 to 1.95). Internal mammary artery (IMA)
grafting was performed less frequently among women than men (64.8% versus
78.4%, P < .001). Smaller BSA and absence of IMA grafting were each
associated with increased risk of death (RD) from heart failure. Risk of
death from heart failure (RD [women minus men] = 2.05; CI95%, 0.89 to 3.22)
and hemorrhage (RD [women minus men] = 0.63; CI95%, 0.13 to 1.13) was
greater among women; these accounted for 71.1% of the sex-specific
difference in mortality rates. CONCLUSIONS. Excess risk of hospital
mortality among women having CABG was largely the consequence of death from
heart failure and, to a lesser extent, from hemorrhage. Smaller BSA
(probably because of its association with coronary artery luminal diameter)
and the absence of IMA grafting were each associated with increased risk of
death from heart failure.
ARTICLES
Differences between men and women in hospital mortality associated with coronary artery bypass graft surgery. The Northern New England Cardiovascular Disease Study Group
Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756.
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