IS SEX A FACTOR IN DETERMINING OPERATIVE RISK FOR AORTOCORONARY BYPASS GRAFT-SURGERY

Background This study examines trends and sex differences in character istics of patients referred for bypass graft surgery to identify facto rs associated with operative morbidity and mortality. Methods and Resu lts Data were collected prospectively on consecutive patients (1132 me n and 355 women). Over time, the proportion of patients >65 years old, with diabetes, or requiring urgent surgery, increased. Predictors of mortality were age >75 years, urgent surgery, and poor left ventricula r (LV) grade. Women were older (62+/-9 versus 59+/-9 years, P<.001) an d had more varicose veins (18% versus 7%, P<.001), diabetes (27% versu s 18%, P<.001), hypertension (48% versus 41%, P<.05), peripheral vascu lar disease (16% versus 12%, P<.05), and more severe angina (P<.001). There were no sex differences in prior myocardial infarction (59% vers us 62%) or need for urgent surgery (17% versus 18%). Women had a highe r ejection fraction (51%+/-12% versus 47%+/-14%, P<.001) and fewer dis eased vessels (2.4+/-0.7 versus 2.6+/-0.6, P<.001) and received fewer grafts (2.9+/-0.9 versus 3.3+/-0.8, P<.001). Women had smaller body si ze but were no more likely to have small target vessels (<1.5 mm). The re was no sex difference in operative mortality (1.4% versus 1.1%), pe rioperative myocardial infarction (4.8% versus 3.5%), need for intra-a ortic balloon pump (10% versus 8%), stroke (1.7% versus 1.4%), reexplo ration for bleeding (1.7% versus 1.7%), or leg infection (2.0% versus 1.4%). Women had fewer sternal wound infections (0.6% versus 2.2%, P<. 05). Conclusions Predictors of mortality include advanced age, decreas ed LV function, and need for urgent surgery. With time, despite increa sing age, associated diabetes, and increased urgent surgery, operative mortality has decreased. Women were older and had more diabetes and h ypertension but less extensive disease and better LV function. Bypass graft surgery was associated with equally low mortality in women and m en (1.4% versus 1.1%). Concern over increased operative mortality in w omen should not bias referral patterns for angiography and coronary by pass graft surgery.