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31st Annual Meeting Abstracts: Assessment of Independent Predictors for Long-Term Mortality between Women and Men Following Coronary Artery Bypass Grafting: Are Women Different than Men?
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17. Assessment of Independent Predictors for Long-Term Mortality between Women and Men Following Coronary Artery Bypass Grafting: Are Women Different than Men?
I. K. Toumpoulis1, C. E. Anagnostopoulos2, S. Balaram1, C. Rokkas2, D. G. Swistel1, R. C. Ashton1, J. J. DeRose1. 1St. Luke's - Roosevelt Hospital Center, Columbia University, New York, NY, 2University Hospital of Athens, Attikon Hospital Center, Athens, Greece,
BACKGROUND: The long-term mortality of CABG in women in not certain. The purpose of this study was to determine and compare risk factors for long-term mortality in women and men.
METHODS: Between 1992 and 2002, 3760 consecutive patients (2598 men and 1162 women) underwent isolated CABG. Long-term survival data were obtained from the National Death Index (mean follow-up 5.1±3.2 years). Multivariable Cox regression analysis for long-term mortality was performed including 64 pre-, intra- and postoperative factors separately in women and men.
RESULTS: There was no difference in early mortality and female sex was not an independent predictor for long-term mortality. Twenty-one independent predictors for long-term mortality were determined in men, while only 12 in women. There were 9 common risk factors (table), however their weights were different.
Malignant ventricular arrhythmias, calcified aorta and preoperative renal failure were independent predictors only in women.
Emergent operation, previous cardiac operation, peripheral vascular disease, left ventricular hypertrophy, current and past congestive heart failure, chronic obstructive pulmonary disease, body mass index >29, preoperative dialysis, preoperative thrombolysis, intraoperative stroke and postoperative renal failure were independent predictors only in men.
CONCLUSIONS: Despite equality between sexes in early and long-term survival there were 3 independent predictors for long-term mortality after CABG unique for women compared to 12 for men. Clinical decision making and follow-up should not influenced by stereotypes, but by specific findings.
Common independent predictors for long-term mortality | Variable | CABG in men | CABG in women | | Age | 1.059 (1.049-1.070); P<0.001 | 1.063 (1.048-1.079); P<0.001 | | Ejection fraction category (1: <30%, 2: 30-50%, 3: >50% | 0.79 (0.68-0.91); P=0.001 | 0.62 (0.51-0.76); P<0.001 | | Diabetes mellitus | 1.49 (1.24-1.80); P<0.001 | 1.37 (1.06-1.76); P=0.016 | | 2 or more arterial grafts | 0.75 (0.63-0.90); P=0.002 | 0.74 (0.56-0.98); P=0.035 | | Postoperative myocardial infarction | 2.16 (1.01-4.60); P=0.046 | 3.62 (1.46-8.96); P=0.005 | | Deep sternal wound infection | 2.16 (1.18-3.97); P=0.001 | 3.62 (1.71-7.67); P=0.001 | | Sepsis and/or endocarditis | 2.44 (1.44-4.14); P=0.001 | 2.72 (1.20-6.15); P=0.017 | | Gastrointestinal complications | 1.73 (1.06-2.82); P=0.029 | 3.59 (1.64-7.88); P=0.001 | | Respiratory failure | 2.09 (1.46-2.97); P<0.001 | 2.51 (1.63-3.86); P<0.001 |
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