Coronary artery surgery in women compared with men: analyses of risks and long-term results

A surgical experience with 2,445 consecutive women who underwent isolated bypass grafting was analyzed for comparison with 18,079 consecutive men. Severe or unstable angina occurred preoperatively in 60% of women and 45% of men (p less than 0.001). Despite less three vessel disease (44 versus 56%, p less than 0.001) and better left ventricular contraction (normal in 60% of women and 53% of men [p less than 0.001]), women had a higher operative mortality rate (2.9 versus 1.3%). When matched for age, severity of angina and extent of coronary atherosclerosis, women still had twice the operative mortality of men. In matched patients, body surface area was the strongest predictor of operative risk, even when the model was adjusted for gender. When the model was adjusted for body surface area, gender was not an important predictor of operative death. The smaller size of women, rather than their sex, appears to explain the difference in operative mortality. After a mean interval of 2 years, women had a lower overall graft patency rate (76.4%) than men (82.1%) (p less than 0.001). At 5 and 10 years postoperatively, a higher percent of men were angina-free. Yet, survival for women (90.6%) and for men (93.0%) at 5 years, and at 10 years (78.6 and 78.2%, respectively) was not dissimilar.

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				G. T. Christakis, R. D. Weisel, K. J. Buth, S. E. Fremes, V. Rao, K. P. Panagiotopoulos, J. Ivanov, B. S. Goldman, and T. E. David IS BODY SIZE THE CAUSE FOR POOR OUTCOMES OF CORONARY ARTERY BYPASS OPERATIONS IN WOMEN? J. Thorac. Cardiovasc. Surg., November 1, 1995; 110(5): 1344 - 1358. [Abstract] [Full Text]

				L. L. Mickleborough, Y. Takagi, H. Maruyama, Z. Sun, and S. Mohamed Is Sex a Factor in Determining Operative Risk for Aortocoronary Bypass Graft Surgery? Circulation, November 1, 1995; 92(9): 80 - 84. [Abstract] [Full Text]

				J. R. Utley, E. F. Wilde, S. A. Leyland, M. S. Morgan, and H. D. Johnson Intraoperative Blood Transfusion Is a Major Risk Factor for Coronary Artery Bypass Grafting in Women Ann. Thorac. Surg., September 1, 1995; 60(3): 570 - 574. [Abstract] [Full Text]

				M. R. Bell, D. E. Grill, K. N. Garratt, P. B. Berger, B. J. Gersh, and D. R. Holmes Jr Long-term Outcome of Women Compared With Men After Successful Coronary Angioplasty Circulation, June 15, 1995; 91(12): 2876 - 2881. [Abstract] [Full Text]

				K. D. Aaronson, J. S. Schwartz, J. E. Goin, and D. M. Mancini Sex Differences in Patient Acceptance of Cardiac Transplant Candidacy Circulation, June 1, 1995; 91(11): 2753 - 2761. [Abstract] [Full Text]

				R. C. Hendel, M. H. Chen, G. J. L'Italien, J. B. Newell, S. D. Paul, K. A. Eagle, and J. A. Leppo Sex Differences in Perioperative and Long-term Cardiac Event–Free Survival in Vascular Surgery Patients : An Analysis of Clinical and Scintigraphic Variables Circulation, February 15, 1995; 91(4): 1044 - 1051. [Abstract] [Full Text]

				J. S. Carey, R. A. Cukingnan, and L. K. M. Singer Health Status After Myocardial Revascularization: Inferior Results in Women Ann. Thorac. Surg., January 1, 1995; 59(1): 112 - 117. [Abstract] [Full Text]

				A K Sullivan, D R Holdright, C A Wright, J L Sparrow, D Cunningham, and K M Fox Chest pain in women: clinical, investigative, and prognostic features BMJ, April 2, 1994; 308(6933): 883 - 886. [Abstract] [Full Text]

				N. K. Wenger, L. Speroff, and B. Packard Cardiovascular Health and Disease in Women N. Engl. J. Med., July 22, 1993; 329(4): 247 - 256. [Full Text]

				Key West abstracts Perfusion, May 1, 1993; 8(3): 249 - 274. [PDF]

				V. Vaccarino, J. L. Abramson, E. Veledar, and W. S. Weintraub Sex Differences in Hospital Mortality After Coronary Artery Bypass Surgery: Evidence for a Higher Mortality in Younger Women Circulation, March 12, 2002; 105(10): 1176 - 1181. [Abstract] [Full Text] [PDF]