E. Simchen et al., ISRAELI WOMEN WERE AT A HIGHER RISK THAN MEN FOR MORTALITY FOLLOWING CORONARY-BYPASS SURGERY, European journal of epidemiology, 13(5), 1997, pp. 503-509
As part of a national study of surgical departments in Israel, cardiac
surgery patients undergoing open heart surgery between 1987 and 1989
were followed-up prospectively. Of these, 1,046 patients had coronary
artery bypass grafting (CABG) and are the subject of this report. The
six-months mortality after surgery was 12.9% among 202 women and 4.1%
among 844 men. Female gender was an independent predictor of mortality
even after controlling for the effect of 14 putative risk factors. Th
e adjusted relative risk for mortality in women compared to men was 2.
79 (1.5-5.2). In an attempt to understand this excessive mortality amo
ng women, a detailed analysis in one of the participating hospitals re
vealed differences associated with surgical technique by gender, such
as proportion of patients with entirely venous grafting vs internal ma
mmary artery grafts (IMA). Thirty percent of women vs 4.8% of men had
entirely venous grafting. Adjusting the data for differences in the pr
oportion of venous grafting has obliterated the difference in mortalit
y between the genders in that hospital. We suggest that interventions
to reduce mortality among women should involve a more careful choice o
f female candidates for CABG surgery, as well as introduction of modif
ications in the operating technique.