Abstract 2538: Off-pump Techniques Disproportionately Benefit Women and Neutralize the Gender Disparity in Outcomes after Coronary Artery Bypass Surgery
Context: Women suffer greater morbidity and mortality than men after conventional coronary artery bypass grafting (CABG) on cardiopulmonary bypass (CPB).
Objective: To determine whether off-pump CABG (OPCAB) alters this gender-based disparity.
Design, Setting and Patients: 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: OPCAB or CABG/CPB, performed at the discretion of 14 faculty surgeons.
Main Outcome Measures: In-hospital death, stroke, myocardial infarction (MI) or combined major adverse cardiac events (MACE=death or stroke or MI). 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.
Results: 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=.01), 1.71 for stroke (p=.007), 2.26 for MI (p=.008) and 1.71 for MACE (p<.001) compared to 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 2.56 CPB versus OPCAB, p=.001), stroke (OR 2.32, p=.002) and MACE (OR 2.33, p<.001).
Conclusions: OPCAB is associated with fewer major adverse cardiac events and benefits women disproportionately, thereby neutralizing the gender disparity in clinical outcomes after CABG.