NEW YORK (Reuters Health) – Operative mortality after coronary artery bypass grafting (CABG) is higher in women, even after adjustment for preoperative risk factors, according to a study of nearly 40,000 patients.

When women have indications for coronary angiography, “particular attention should be paid to averting delay in referral,” principal investigator Dr. Ezra A. Amsterdam told Reuters Health.

It’s essential, he added, that cardiologists and primary care doctors “be attuned to…indicators in women,” which often differ from classic ones in men.

Dr. Amsterdam and his colleagues at the University of California, Davis Medical Center in Sacramento used the 2003 and 2004 California CABG Outcomes Reporting Program to evaluate factors related to operative mortality after isolated CABG. Operative deaths were those that occurred while the patient was still hospitalized after the surgery, or outside the hospital for up to 30 days after CABG.

In the December 21st online issue of the American Journal of Cardiology, the researchers tell what they learned in their evaluation of data from 29,699 male and 10,708 female CABG patients.

Observed mortality was significantly higher in women (4.60%) than in men (2.53%; p < 0.0001), the authors report. On multivariate analysis, women faced a 61% higher risk of operative mortality.

The difference in operative mortality was evident across all age groups, but the greatest difference was between women and men younger than 65 years of age. The odds ratio of operative mortality was 2.13 in these younger women, compared to men.

The men in this study more often had left ventricular dysfunction and more than three diseased coronary arteries, while women were more likely to have diabetes, stage 3 to 5 chronic kidney disease, and chronic lung disease.

Women were also more likely to undergo nonselective CABG.

“Coronary disease may have a different presentation in women than men, although this is certainly not always true,” Dr. Amsterdam said. “It is important that physicians recognize that heart disease is the leading cause of death in women and this becomes very important about 10 years after menopause.”

“It is important that physicians manage coronary and other cardiac diseases in women just as we do in men, by applying evidence-based medicine as reflected in current guidelines to both sexes (and) that we correct the delay in referral of women for diagnostic tests and further management of evidence of heart disease,” he continued.

“In virtually all current approaches to heart disease, studies have shown that the benefit” of CABG “in women is comparable to that in men.”

In California, Dr. Amsterdam pointed out, “We continue to monitor all CABG…and we have expanded our database” in order to test the effects of additional pre-, peri-, and post-operative factors.

Reference:
Am J Cardiol 2009.