Acute Outcome

The Big Heart Disease Lie

Curing Heart Disease Forever

Get Instant Access

Improvements in myocardial protection and advances in surgical techniques have allowed surgical revascularization procedures to be offered to a larger subset of women with symptomatic coronary heart disease. Despite these advances, gender differences in in-hospital mortality following coronary artery bypass surgery have persisted and have been notably consistent during the past 20 yr (Table 3). Specifically, in-hospital mortality is approx 2.5-fold higher in women in comparison with men, is only partially explained by older age and a higher risk profile in women (102,103), and has been attributed to more urgent or emergency procedures owing to unstable symptoms as well as greater technical difficulty in operating in women (102). Small coronary vessel diameter has been associated with increased mortality, and several studies have reported that when body surface area (a surrogate for vessel size) is considered, female gender is no longer an independent predictor of in-hospital mortality (104). Congestive heart failure has been shown to be independently associated with mortality (105), particularly in women, as well as excess hemorrhagic complications.

These observations have been confirmed in a recent retrospective study of 4823 patients, including 932 (19.3%) women, undergoing coronary artery bypass surgery that revealed significant gender-based differences in morbidity and mortality. Compared to men, women who underwent coronary artery bypass surgery were older, had a smaller mean body surface area, and a higher prevalence of diabetes, hypertension, peripheral vascular disease, congestive heart failure, history of percutaneous revascularization procedures, and NYHA class III or IV angina. Women were more likely to require urgent surgery with an increased frequency of preoperative intra-aortic balloon pump usage. Women had fewer bypass grafts constructed than men and were less likely to have inter-

IH Postoperative transfusion *p=0.001 vs. OPCAB

IH Postoperative transfusion *p=0.001 vs. OPCAB

OPCAB CABG

Fig. 9. Complications following "off-pump" surgical revascularization. In a series of women deemed appropriate for "off-pump" surgical revascularization, postoperative complications were significantly decreased as compared to women who underwent traditional surgical revascularization procedures. OPCAB, "off-pump" coronary artery bypass; CABG, coronary artery bypass grafting; TIA/CVA, transient ischemic attack/cerebrovascular accident (107).

OPCAB CABG

Fig. 9. Complications following "off-pump" surgical revascularization. In a series of women deemed appropriate for "off-pump" surgical revascularization, postoperative complications were significantly decreased as compared to women who underwent traditional surgical revascularization procedures. OPCAB, "off-pump" coronary artery bypass; CABG, coronary artery bypass grafting; TIA/CVA, transient ischemic attack/cerebrovascular accident (107).

nal mammary artery grafting, multiple arterial conduits, or coronary endarterectomy performed at the time of surgery. The early mortality rate in women in this series was 2.7 vs 1.8% in men (p = 0.09), and women were found to be more prone to perioperative myocardial infarction (4.5 vs 3.1% p < 0.05). Interestingly, after adjustment for other risk factors, female gender was not an independent predictor of early mortality, but was a weak independent predictor for the composite end point of death, perioperative myocardial infarction, intra-aortic balloon pump placement, or cerebrovascular accident (8.55 vs 5.9%; odds ratio, 1.30; 95% CI: 0.99-1.68; p = 0.05). Recurrent anginal symptoms were more frequent in female patients (15.2 ± 4.0% vs 8.5 ± 2.0% at 60 mo, p = 0.001) but did not result in an increase in repeat percutaneous or surgical revascularization procedures (106).

Surgical myocardial revascularization in women has increasingly been performed utilizing an off-pump (without cardiopulmonary bypass) technique (Fig. 9). In a series of patients deemed appropriate for off-pump revascularization procedures, the mortality for women was lower compared to their on-pump counterparts, despite an older age and higher incidence of diabetes. In fact, the mortality rate for women operated on without cardiopulmonary bypass dropped to the mortality rate typically seen in men. This was associated with a shorter length of stay and a lower incidence of transient ischemic attacks, cerebrovascular accidents, postoperative bleeding complications, and blood transfusions; however, these favorable outcomes in women may reflect patient selection and require further study (107).

Historically, women undergoing coronary angioplasty had a lower procedural success rate than men (108); however, recent reports have demonstrated similar angiographic outcome and rates of periprocedural myocardial infarction and emergency coronary bypass surgery (Table 4) (97,105). Yet, in-hospital mortality is significantly higher in

Table 4

Gender Differences in Acute Outcome in Patients Undergoing Percutaneous Coronary Interventions3

Table 4

Gender Differences in Acute Outcome in Patients Undergoing Percutaneous Coronary Interventions3

Authors

Patients

Angiographic

Death

Nonfatal

Was this article helpful?

0 0
Delicious Diabetic Recipes

Delicious Diabetic Recipes

This brilliant guide will teach you how to cook all those delicious recipes for people who have diabetes.

Get My Free Ebook


Post a comment