Early and mid term mortality after coronary artery bypass grafting in women depends on the surgical protocol: retrospective analysis of 3441 on- and off-pump coronary artery bypass grafting procedures

Background: Since 2002 MI and stroke, not cancer, are leading
causes of death in women. We studied 30-days and 1 year mortality
of 3441 patients undergoing coronary artery bypass grafting (CABG)
operations in our institution performed either conventionally or
off pump (OPCAB). Our objective was to investigate the
gender-related mortality in both groups. Patients and Methods:
Between 2004 and 2008, 3441 patients (733 women, 2708 men)
underwent CABG. 252 women and 854 men were operated using OPCAB,
481 women and 1854 men using extracorporeal circulation (ECC).
Medical data was prospectively entered and retrospectively
reviewed. 30-days and one year mortality rates were analyzed with
Kaplan-Meier estimates and Cox proportional hazards models. Linear
and logistic regression models were used to test gender
differences. Results: a) 30-day mortality using ECC: 5.2% in women
vs. 2.5% in men (p = 0.001). One year ECC mortality: 8.7% in women
vs. 4.8% in men (p = 0.0008). b) OPCAB: 30-days and 1 year
mortality in women measured 1.7%. Mortality in men was 2.1% after
30 days and 3.7% after one year c) gender specific mortality: 30
days mortality in women was 1.7% using OPCAB and 5.2% using ECC (p
= 0.002), one year mortality in women was 1.7% using OPCAB vs. 8.7%
using ECC (p = 0.0004). In men, 30-days mortality in OPCAB was
2.1%, one year mortality was 3.7%; using ECC early and late
mortality was 2.5% and 4.8%. Conclusions: Female gender is a strong
independent predictor and risk factor of increased early and
midterm postoperative mortality rates when ECC is used. OPCAB
significantly reduces early and midterm postoperative mortality in
women and may therefore be proposed as the preferred
revascularization technique in female patients.