Clinical Research in Cardiology

, Volume 101, Issue 9, pp 745–751

Gender-specific predictors of early mortality after coronary artery bypass graft surgery

  • E. Lehmkuhl
  • F. Kendel
  • G. Gelbrich
  • A. Dunkel
  • S. Oertelt-Prigione
  • B. Babitsch
  • C. Knosalla
  • N. Bairey-Merz
  • R. Hetzer
  • V. Regitz-Zagrosek
Original Paper

Abstract

Background

Female gender is a risk factor for early mortality after coronary artery bypass graft surgery (CABG). Yet, the causes for this excess mortality in women have not been fully explained.

Objectives

To analyse gender differences in early mortality (30 days post surgery) after CABG and to identify variables explaining the association between female gender and excess mortality, taking into account preoperative clinical and psychosocial, surgical and postoperative risk factors.

Methods

A total of 1,559 consecutive patients admitted to the German Heart Institute Berlin (2005–2008) for CABG were included in this prospective study. A comprehensive set of prespecified preoperative, surgical and postoperative risk factors were examined for their ability to explain the gender difference in early mortality.

Results

Early mortality after CABG was higher in women than in men (6.9 vs. 2.4 %, HR 2.91, 95 % CI 1.70–4.96, P < 0.001). Women were older than men (+4.7 years, P < 0.001), had lower self-assessed preoperative physical functioning (−16 points on a scale from 0 to 100, P < 0.001), and had higher rates of postoperative low cardiac output syndromes (6.6 vs. 3.3 %, P = 0.01), respiratory insufficiency (9.4 vs. 5.3 %, P = 0.006) and resuscitation (5.2 vs. 1.8 %, P = 0.001). The combination of these factors explained 71 % of the gender difference in early mortality; age and physical functioning alone accounted for 61 %. Adjusting for these variables, HR for female gender was 1.36 (95 % CI 0.77–2.41, P = 0.29).

Conclusions

Age, physical function and postoperative complications are key mediators of the overmortality of women after aortocoronary bypass surgery. Self-assessed physical functioning should be more seriously considered in preoperative risk assessment particularly in women.

Keywords

Gender Sex Heart failure Early mortality Coronary artery bypass graft surgery Risk factors 

Supplementary material

392_2012_454_MOESM1_ESM.doc (140 kb)
Supplementary material 1 (DOC 140 kb)

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • E. Lehmkuhl
    • 1
  • F. Kendel
    • 2
  • G. Gelbrich
    • 3
  • A. Dunkel
    • 8
  • S. Oertelt-Prigione
    • 8
  • B. Babitsch
    • 5
  • C. Knosalla
    • 1
  • N. Bairey-Merz
    • 6
  • R. Hetzer
    • 1
  • V. Regitz-Zagrosek
    • 1
    • 4
    • 7
  1. 1.Department of Cardiothoracic and Vascular SurgeryDeutsches Herzzentrum BerlinBerlinGermany
  2. 2.Institute of Medical PsychologyCharité-Universitätsmedizin BerlinBerlinGermany
  3. 3.Clinical Trial Centre LeipzigUniversity of LeipzigLeipzigGermany
  4. 4.Institute for Gender in MedicineCharité-Universitätsmedizin BerlinBerlinGermany
  5. 5.Berlin School of Public HealthCharité-Universitätsmedizin BerlinBerlinGermany
  6. 6.Cedars Sinai HospitalLos AngelesUS
  7. 7.Center for Cardiovascular Research (CCR)Charité-Universitätsmedizin BerlinBerlinGermany
  8. 8.Institute for Gender in MedicineCharité-Universitätsmedizin BerlinBerlinGermany

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