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(Circulation. 2007;116:I-192 – I-199.)
© 2007 American Heart Association, Inc.

Surgery for Coronary Artery Disease

Off-Pump Techniques Disproportionately Benefit Women and Narrow the Gender Disparity in Outcomes After Coronary Artery Bypass Surgery

John D. Puskas, MD; Patrick D. Kilgo, MS; Michael Kutner, PhD; Sorin V. Pusca, MD; Omar Lattouf, MD; Robert A. Guyton, MD

From the Emory Heart Center (J.D.P., S.V.P., O.L., R.A.G.), Division of Cardiothoracic Surgery, Clinical Research Unit, Emory University School of Medicine, Atlanta, Ga; and the Department of Biostatistics (P.D.K., M.K.), Rollins School of Public Health, Emory University, Atlanta, Ga.

Correspondence to John D. Puskas, MD, MSc, Associate Chief of Cardiothoracic Surgery, Emory University, Chief of Cardiac Surgery, Emory Crawford Long Hospital, 6th Floor Medical Office Tower, 550 Peachtree St NE, Atlanta, GA 30308. E-mail john.puskas{at}emoryhealthcare.org

Background— Women experience greater morbidity and mortality than men after conventional coronary artery bypass grafting (CABG) on cardiopulmonary bypass (CPB). The objective of this study was to determine whether off-pump CABG (OPCAB) alters this gender-based disparity.

Methods and Results— Retrospective review of risk factors and clinical outcomes for 11 413 consecutive patients having isolated CABG between January 1, 1997, and May 31, 2005, at a US academic center. Interventions were OPCAB or CABG/CPB, performed at the discretion of 14 faculty surgeons. Main outcome measures included in-hospital death, stroke, myocardial infarction or combined major adverse cardiac events (MACE=death or stroke or myocardial infarction). Odds ratios of adverse events, adjusted for 31 risk factors, were compared between women and men who had OPCAB versus CABG/CPB. Covariates included Propensity Score, Society of Thoracic Surgeons’ Predicted Risk, surgeon and body habitus. Female patients (n=3248) and those treated with OPCAB (n=4492) were older, had more comorbidities and higher predicted risk than male patients (n=8165) and those treated with conventional CABG/CPB (n=6921), respectively. Women treated with CABG/CPB had a risk-adjusted odds ratio of 1.60 for death (P=0.01), 1.71 for stroke (P=0.007), 2.26 for myocardial infarction (P=0.008) and 1.71 for MACE (P<0.001) compared with men who had CABG/CPB. In contrast, women treated with OPCAB had outcomes statistically similar to men who had either OPCAB or CABG/CPB. Among women, OPCAB was associated with a significant reduction in death (OR 0.39, P=0.001), stroke (OR 0.43, P=0.002) and MACE (OR 0.43, P<0.001).

Conclusions— OPCAB is associated with fewer major adverse cardiac events and benefits women disproportionately, thereby narrowing the gender disparity in clinical outcomes after CABG.

Key Words: cardiopulmonary bypass • surgery • coronary disease