Gender differences in the surgical management and early clinical outcome of coronary artery disease: Single centre experience

ABSTRACT

To investigate the gender disparity in the distribution of patient-related risk factors and their effect on the surgical management and clinical outcome of coronary artery disease in Saudi population. We carried out a retrospective analysis of prospectively collected data of 971 patients undergoing isolated coronary artery bypass grafting [CABG] at our institution between January 2005 and December 2008. Seven hundred and eighty seven patients [81%] were males and 184 patients [19%] were females. We analyzed gender-based difference in clinical presentation and patient-related pre-operative risk factors and studied their impact on surgical management and clinical outcome. The mean age was 59.5 years in males and 63.4 years in females [p = < 0.0001]. Associated co-morbidities were higher in females. Prevalence of diabetes mellitus was 61.2% in males and 78.8% in females [p-value < 0.0001]; hypertension 61.9% in males and 79.9% in females [p-value < 0.0001]; hyperlipidemia 66.7% in males and 77.7% in females [p-value 0.0035]; morbid obesity 24.7% in males and 45.1% in females [p-value < 0.0001]; and Hypothyroidism 2.5% in males and 13.6% in females [p-value < 0.0001]. Smoking was the only risk factor with higher prevalence in males compared to females [44.2% v/s 2.2%; p-value < 0.0001]. The mean logistic euro-SCORE was 3.94 in males and 5.51 in females [p < 0.0003]. On-pump and off-pump CABG was carried out in equal numbers in two groups. Females required urgent surgery and less than 3 grafts more frequently while males underwent elective surgery and more than 3 grafts in greater numbers. No significant difference was present between the two gender groups in aortic occlusion times and bypass times. Univariant analysis revealed females gender as an independent risk factor for higher in-hospital mortality [1.1% versus 4.9% p = 0.0026] and higher incidence of post-operative complications like surgical wound infection, need for prolonged ventilation, low cardiac output state and multi-organ failure [p-values 0.01 or less]. Female gender is an independent predictor of adverse outcome after isolated CABG due to significantly higher co-morbidities and acute presentation and independent of their peri-operative management. Therefore, major socioeconomic education and preventive measures are needed to reduce the burden of major co-morbidities in females and to seek early cardiac advice and care