Document Type : Original Article(s)
Authors
1 Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Cardiology, School of medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Department of Cardiac Surgery, School of medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4 Department of Clinical Pharmacy, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract
Background: Gender impacts pre-, intra-, and postoperative parameters and outcomes following coronary artery bypass graft (CABG) with conflicting results. This study aimed to identify differences in preoperative, intraoperative, and postoperative parameters. It also seeks to compare the postoperative complications and mortality between two genders who had CABG surgery.
Method: This prospective observational study included patients who had isolated CABG and were divided based on gender. Demographic information, underlying comorbidities, drug history, clinical and laboratory data at the time of referral, operative characteristics, postoperative variables, and mortality outcomes were tracked during hospitalization and six months after discharge.
Results: Three hundred twenty patients were enrolled in the study during its duration. 71% were male. Women were older (62.40±9.03 vs. 59.99±9.81 years, p= 0.011) and had more dyslipidemia (p=0.003), hypertension (p=0.000), and diabetes (p=0.001), whereas men admitted with more myocardial infarction (MI) (p=0.011) and had lower Ejection fraction (EF) (p=0.001). They also had lower EF post-surgery (p <0.001) and six months after discharge (p = 0.006). However, the number of vessels involved was not different between genders (p=0.589), but the number of grafts was higher in men (p=0.008).
There was no statistically significant difference in overall mortality rates between the two groups (4.42% and 6.38% in men and women, respectively, p= 0.464).
Conclusions: The women had more underlying comorbidities than men. Furthermore, there were some differences in the intra-operative parameters and postoperative complications between the two genders, but there was no difference in postoperative mortality in our setting.
Highlights
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Keywords
2. Neumann F-J, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2018; 40(2): 87-165.
3. Shahian DM, O’Brien SM, Sheng S, Grover FL, Mayer JE, Jacobs JP, et al. Predictors of long-term survival after coronary artery bypass grafting surgery: results from the Society of Thoracic Surgeons Adult Cardiac Surgery Database (the ASCERT study). Circulation. 2012; 125(12): 1491-500.
4. Weintraub WS, Clements Jr SD, Crisco LV-T, Guyton RA, Craver JM, Jones EL, et al. Twenty-year survival after coronary artery surgery: an institutional perspective from Emory University. Circulation. 2003; 107(9): 1271-7.
5. DeBakey ME, Glaeser DH. Patterns of atherosclerosis: effect of risk factors on recurrence and survival—analysis of 11,890 cases with more than 25-year follow-up. Am J cardiol. 2000; 85(9): 1045-53.
6. Becker ER, Granzotti AM. Trends in In-hospital Coronary Artery Bypass Surgery Mortality by Gender and Race/Ethnicity --1998-2015: Why Do the Differences Remain? J Natl Med Assoc. 2019; 111(5): 527-39.
7. Cooper WA, Thourani VH, Guyton RA, Kilgo P, Lattouf OM, Chen EP, et al. Racial disparity persists after on-pump and off-pump coronary artery bypass grafting. Circulation. 2009; 120(11): S59-S64.
8. Mehta RH, Shahian DM, Sheng S, O’Brien SM, Edwards FH, Jacobs JP, et al. Association of hospital and physician characteristics and care processes with racial disparities in procedural outcomes among contemporary patients undergoing coronary artery bypass grafting surgery. Circulation. 2016; 133(2): 124-30.
9. Khera R, Vaughan-Sarrazin M, Rosenthal GE, Girotra S. Racial disparities in outcomes after cardiac surgery: the role of hospital quality. Curr Cardiol Rep. 2015; 17(5): 29.
10. Swaminathan RV, Feldman DN, Pashun RA, Patil RK, Shah T, Geleris JD, et al. Gender differences in in-hospital outcomes after coronary artery bypass grafting. Am J cardiol. 2016; 118(3): 362-8.
11. Saxena A, Dinh D, Smith JA, Shardey G, Reid CM, Newcomb AE. Sex differences in outcomes following isolated coronary artery bypass graft surgery in Australian patients: analysis of the Australasian Society of Cardiac and Thoracic Surgeons cardiac surgery database. Eur J Cardiothorac surg. 2012; 41(4): 755-62.
12. Johnston A, Mesana TG, Lee DS, Eddeen AB, Sun LY. Sex differences in long‐term survival after major cardiac surgery: a population‐based cohort study. J Am Heart Assoc. 2019; 8(17): e013260.
13. Gupta S, Lui B, Ma X, Walline M, Ivascu NS, White RS. Sex differences in outcomes after coronary artery bypass grafting. J Cardiothorac Vasc Anesth. 2020; 34(12): 3259-66.
14. deNeto FJA, Barroso LC, Nunes JKVRS, daSilva Nina VJ. Sex Differences in Mortality After CABG Surgery. Braz J Cardiovasc Surg. 2015; 30(6): 610-4.
15. Angraal S, Khera R, Wang Y, Lu Y, Jean R, Dreyer RP, et al. Sex and race differences in the utilization and outcomes of coronary artery bypass grafting among medicare beneficiaries, 1999–2014. J Am Heart Assoc. 2018; 7(14): e009014.
16. Bagheri J, Sarzaeem MR, Valeshabad AK, Bagheri A, Mandegar MH. Effect of sex on early surgical outcomes of isolated coronary artery bypass grafting. Turk J Thor Cardiovas Sur. 2014; 22(3): 534-539.
17. Yazdanian F, Azarfarin R, Aghdaii N, Jalali Motlagh S, Faritous Z, Alavi M, et al. Relationship between gender and in-hospital morbidity and mortality after coronary artery bypass grafting surgery in an Iranian population. Res Cardiovasc Med. 2012; 1(1): 17-22.
18. Sattartabar B, Ajam A, Pashang M, Jalali A, Sadeghian S, Mortazavi H, et al. Sex and Age Difference in Risk Factor Distribution, Trend, and Long-Term Outcome of Patients Undergoing Isolated Coronary Artery Bypass Graft Surgery. BMC Cardiovasc Disord. 2021; 21(1): 460.
19. Chrysohoou C, Aggeli C, Avgeropoulou C, Aroni M, Bonou M, Boutsikou M, et al. Cardiovascular disease in women: Executive summary of the expert panel statement of women in cardiology of the hellenic cardiological society. Hellenic J Cardiol. 2020; 61(6): 362-77.
20. Blankstein R, Ward RP, Arnsdorf M, Jones B, Lou Y-B, Pine M. Female gender is an independent predictor of operative mortality after coronary artery bypass graft surgery: contemporary analysis of 31 Midwestern hospitals. Circulation. 2005; 112(9): I323-7.
21. Hammar N, Sandberg E, Larsen FF, Ivert T. Comparison of early and late mortality in men and women after isolated coronary artery bypass graft surgery in Stockholm, Sweden, 1980 to 1989. J Am Coll Cardiol. 1997; 29(3): 659-64.
22. Gurram A, Krishna N, Vasudevan A, Baquero LA, Jayant A, Varma PK. Female gender is not a risk factor for early mortality after coronary artery bypass grafting. Ann Card Anaesth. 2019; 22(2): 187.
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