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

Published:December 17, 2014DOI:
      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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        • Alam M.
        • Bandeali S.J.
        • Kayani W.T.
        • Ahmad W.
        • Shahzad S.A.
        • Jneid H.
        • Birnbaum Y.
        • Kleiman N.S.
        • Coselli J.S.
        • Ballantyne C.M.
        • Lakkis N.
        • Virani S.S.
        Comparison by meta-analysis of mortality after isolated coronary artery bypass grafting in women versus men.
        Am J Cardiol. 2013; 112: 309-317
        • Saxena A.
        • Dinh D.
        • Smith J.A.
        • Shardey G.
        • Reid C.M.
        • Newcomb A.E.
        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: 755-762
        • Abramov D.
        • Tamariz M.G.
        • Sever J.Y.
        • Christakis G.T.
        • Bhatnagar G.
        • Heenan A.L.
        • Goldman B.S.
        • Fremes S.E.
        The influence of gender on the outcome of coronary artery bypass surgery.
        Ann Thorac Surg. 2000; 70 (discussion 806): 800-805
        • Sharoni E.
        • Kogan A.
        • Medalion B.
        • Stamler A.
        • Snir E.
        • Porat E.
        Is gender an independent risk factor for coronary bypass grafting?.
        Thorac Cardiovasc Surg. 2009; 57: 204-208
        • Al-Alao B.S.
        • Parissis H.
        • McGovern E.
        • Tolan M.
        • Young V.K.
        Gender influence in isolated coronary artery bypass graft surgery: a propensity match score analysis of early outcomes.
        Gen Thorac Cardiovasc Surg. 2012; 60: 417-424
        • Bukkapatnam R.N.
        • Yeo K.K.
        • Li Z.
        • Amsterdam E.A.
        Operative mortality in women and men undergoing coronary artery bypass grafting (from the California Coronary Artery Bypass Grafting Outcomes Reporting Program).
        Am J Cardiol. 2010; 105: 339-342
        • Bridges C.R.
        • Edwards F.H.
        • Peterson E.D.
        • Coombs L.P.
        The effect of race on coronary bypass operative mortality.
        J Am Coll Cardiol. 2000; 36: 1870-1876
        • Hartz R.S.
        • Rao A.V.
        • Plomondon M.E.
        • Grover F.L.
        • Shroyer A.L.
        Effects of race, with or without gender, on operative mortality after coronary artery bypass grafting: a study using the Society of Thoracic Surgeons National Database.
        Ann Thorac Surg. 2001; 71: 512-520
        • Rangrass G.
        • Ghaferi A.A.
        • Dimick J.B.
        Explaining racial disparities in outcomes after cardiac surgery: the role of hospital quality.
        JAMA Surg. 2014; 149: 223-227
        • Trivedi A.N.
        • Sequist T.D.
        • Ayanian J.Z.
        Impact of hospital volume on racial disparities in cardiovascular procedure mortality.
        J Am Coll Cardiol. 2006; 47: 417-424
        • Yeo K.K.
        • Li Z.
        • Amsterdam E.
        Clinical characteristics and 30-day mortality among Caucasians, Hispanics, Asians, and African-Americans in the 2003 California coronary artery bypass graft surgery outcomes reporting program.
        Am J Cardiol. 2007; 100: 59-63
        • Ad N.
        • Barnett S.D.
        • Speir A.M.
        The performance of the EuroSCORE and the Society of Thoracic Surgeons mortality risk score: the gender factor.
        Interact Cardiovasc Thorac Surg. 2007; 6: 192-195
        • Hillis L.D.
        • Smith P.K.
        • Anderson J.L.
        • Bittl J.A.
        • Bridges C.R.
        • Byrne J.G.
        • Cigarroa J.E.
        • Disesa V.J.
        • Hiratzka L.F.
        • Hutter Jr., A.M.
        • Jessen M.E.
        • Keeley E.C.
        • Lahey S.J.
        • Lange R.A.
        • London M.J.
        • Mack M.J.
        • Patel M.R.
        • Puskas J.D.
        • Sabik J.F.
        • Selnes O.
        • Shahian D.M.
        • Trost J.C.
        • Winniford M.D.
        2011 ACCF/AHA guideline for coronary artery bypass graft surgery: a report of the American College of cardiology Foundation/American heart association Task Force on Practice guidelines.
        Circulation. 2011; 124: e652-e735
        • Shahian D.M.
        • O'Brien S.M.
        • Filardo G.
        • Ferraris V.A.
        • Haan C.K.
        • Rich J.B.
        • Normand S.L.
        • DeLong E.R.
        • Shewan C.M.
        • Dokholyan R.S.
        • Peterson E.D.
        • Edwards F.H.
        • Anderson R.P.
        The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 1—coronary artery bypass grafting surgery.
        Ann Thorac Surg. 2009; 88: S2-S22
        • Ferguson Jr., T.B.
        • Dziuban Jr., S.W.
        • Edwards F.H.
        • Eiken M.C.
        • Shroyer A.L.
        • Pairolero P.C.
        • Anderson R.P.
        • Grover F.L.
        The STS national database: current changes and challenges for the new millennium. Committee to Establish a National Database in Cardiothoracic Surgery, the Society of Thoracic Surgeons.
        Ann Thorac Surg. 2000; 69: 680-691
        • Filardo G.
        • Hamilton C.
        • Hamman B.
        • Ng H.K.
        • Grayburn P.
        Categorizing BMI may lead to biased results in studies investigating in-hospital mortality after isolated CABG.
        J Clin Epidemiol. 2007; 60: 1132-1139
        • Vaccarino V.
        • Abramson J.L.
        • Veledar E.
        • Weintraub W.S.
        Sex differences in hospital mortality after coronary artery bypass surgery: evidence for a higher mortality in younger women.
        Circulation. 2002; 105: 1176-1181
        • Koch C.G.
        • Weng Y.S.
        • Zhou S.X.
        • Savino J.S.
        • Mathew J.P.
        • Hsu P.H.
        • Saidman L.J.
        • Mangano D.T.
        Prevalence of risk factors, and not gender per se, determines short- and long-term survival after coronary artery bypass surgery.
        J Cardiothorac Vasc Anesth. 2003; 17: 585-593
        • Anand S.S.
        • Xie C.C.
        • Mehta S.
        • Franzosi M.G.
        • Joyner C.
        • Chrolavicius S.
        • Fox K.A.
        • Yusuf S.
        • Investigators C
        Differences in the management and prognosis of women and men who suffer from acute coronary syndromes.
        J Am Coll Cardiol. 2005; 46: 1845-1851
        • Ouzounian M.
        • Currie M.E.
        • Buth K.J.
        • Yip A.M.
        • Hassan A.
        • Hirsch G.M.
        Myocardium at risk is associated with adverse clinical events in women but not in men, after coronary artery bypass grafting.
        Can J Cardiol. 2014; 30: 808-813
        • Kim S.G.
        • Apple S.
        • Mintz G.S.
        • McMillan T.
        • Canos D.A.
        • Maehara A.
        • Weissman N.J.
        The importance of gender on coronary artery size: in-vivo assessment by intravascular ultrasound.
        Clin Cardiol. 2004; 27: 291-294
        • Sheifer S.E.
        • Canos M.R.
        • Weinfurt K.P.
        • Arora U.K.
        • Mendelsohn F.O.
        • Gersh B.J.
        • Weissman N.J.
        Sex differences in coronary artery size assessed by intravascular ultrasound.
        Am Heart J. 2000; 139: 649-653
        • Reis S.E.
        • Holubkov R.
        • Conrad Smith A.J.
        • Kelsey S.F.
        • Sharaf B.L.
        • Reichek N.
        • Rogers W.J.
        • Merz C.N.
        • Sopko G.
        • Pepine C.J.
        • Investigators W.
        Coronary microvascular dysfunction is highly prevalent in women with chest pain in the absence of coronary artery disease: results from the NHLBI WISE study.
        Am Heart J. 2001; 141: 735-741
        • Tarakji A.
        • Prasad S.
        • Chedrawy E.
        • Massad M.G.
        Gender disparity in CABG outcomes: an independent risk factor or not, women are at a disadvantage.
        Thorac Cardiovasc Surg. 2009; 57: 202-203
        • Konety S.H.
        • Vaughan Sarrazin M.S.
        • Rosenthal G.E.
        Patient and hospital differences underlying racial variation in outcomes after coronary artery bypass graft surgery.
        Circulation. 2005; 111: 1210-1216
        • Castellanos L.R.
        • Li Z.
        • Yeo K.K.
        • Young J.N.
        • Ayanian J.Z.
        • Amsterdam E.A.
        Relation of race, ethnicity and cardiac surgeons to operative mortality rates in primary coronary artery bypass grafting in California.
        Am J Cardiol. 2011; 107: 1-5
        • Castellanos L.R.
        • Normand S.L.
        • Ayanian J.Z.
        Racial and ethnic disparities in access to higher and lower quality cardiac surgeons for coronary artery bypass grafting.
        Am J Cardiol. 2009; 103: 1682-1686
        • Kurlansky P.A.
        • Traad E.A.
        • Dorman M.J.
        • Galbut D.L.
        • Zucker M.
        • Ebra G.
        Bilateral internal mammary artery grafting reverses the negative influence of gender on outcomes of coronary artery bypass grafting surgery.
        Eur J Cardiothorac Surg. 2013; 44: 54-63
        • Gansera B.
        • Gillrath G.
        • Lieber M.
        • Angelis I.
        • Schmidtler F.
        • Kemkes B.M.
        Are men treated better than women? Outcome of male versus female patients after CABG using bilateral internal thoracic arteries.
        Thorac Cardiovasc Surg. 2004; 52: 261-267