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CLINICAL STUDIES

Worse clinical outcome but similar graft patency in women versus men one year after coronary artery bypass graft surgery owing to an excess of exposed risk factors in women

Eng-Shiong Tan, MD^a, Jan van der Meer, MD^a, Pieter Jan de Kam, MSc^a, Peter H. J. M. Dunselman, MD^*, Barbara J. M. Mulder, MD, Carl A. P. L. Ascoop, MD, Matthias Pfisterer, MD, Kong I. Lie, MD for CABADAS Research Group of the Interuniversity Cardiology Institute of the Netherlands^||

^a Department of Cardiology, University Hospital, Groningen, the Netherlands
^* Department of Cardiology, Ignatius Hospital, Breda, the Netherlands
Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
Department of Cardiology, St. Anthonius Hospital, Nieuwegein, the Netherlands
Department of Cardiology, University Hospital, Basel, Switzerland
^|| A complete list of the prevention of Coronary Artery Bypass graft occlusion by Aspirin, Dipyridamole and Acenocoumarol/phenoprocoumon Study, Sweden

Manuscript received September 10, 1998; revised manuscript received June 8, 1999, accepted August 5, 1999.

Reprint requests and correspondence: Dr. Eng-Shiong Tan, Department of Cardiology, Thoraxcentre, University Hospital, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, the Netherlands
E.S.Tan{at}Thorax.AZG.NL

OBJECTIVES

This retrospective study sought to assess differences in graft patency and clinical outcome between women and men after coronary artery bypass graft surgery (CABG).

BACKGROUND

A less favorable clinical outcome has been reported in women as compared with men. Its relation to graft patency has not been studied.

METHODS

We analyzed one-year follow-up data of 912 patients (120 women) who entered a randomized clinical drug trial. All patients received vein grafts; in 494 patients (56 women) internal mammary artery (IMA) grafts were also used. Graft patency was assessed by coronary angiography at one year. Primary clinical end points were myocardial infarction, revascularization procedures and death; secondary clinical end points included recurrent angina, heart failure and arrhythmias.

RESULTS

Occlusion rates of vein grafts were 16.7% in women and 12.4% in men (odds ratio [OR] 1.62, 95% confidence interval [CI] 0.88 to 3.00, p = 0.12); occlusion rates of IMA grafts were 3.4% and 5.7% in women and men, respectively (OR 0.56, 95% CI 0.08 to 3.96, p = 0.56). Primary clinical end points were observed in 16.7% of women and 9.2% of men (OR 1.97, 95% CI 1.10 to 3.34, p = 0.022), and any clinical end point in 41.7% of women and 25.8% of men (OR 2.06, 95% CI 1.39 to 3.04, p = 0.0004). Myocardial infarction (15% vs. 7.6%, OR 2.15, 95% CI 1.24 to 3.75, p = 0.013) and recurrent angina (26.7% vs. 15.4%, OR 2.00, 95% CI 1.28 to 3.11, p = 0.004) occurred most frequently. Multivariate regression analysis did not identify gender as an independent risk factor for graft occlusion or the clinical end points. Graft occlusion was an independent predictor of the composite primary clinical end point (OR 2.75, 95% CI 1.59 to 4.75, p = 0.0003) and each of the secondary clinical end points. The observed differences were due to an imbalance of risk factors at baseline and to surgical and graft characteristics.

CONCLUSIONS

One-year occlusion rates of vein and IMA grafts were comparable in women and men. Clinical outcome was related to graft patency and was less favorable in women owing to their uneven distribution of risk factors among both groups.

Abbreviations and Acronyms   CABADAS = prevention of Coronary Artery Bypass graft occlusion by Aspirin, Dipyridamole and Acenocoumarol/phenoprocoumon Study   CABG = coronary artery bypass graft surgery   CI = confidence interval   ECG = electrocardiogram   IMA = internal mammary artery   MI = myocardial infarction   NYHA = New York Heart Association   OR = odds ratio

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