Elsevier

The Annals of Thoracic Surgery

Volume 74, Issue 5, November 2002, Pages 1517-1525
The Annals of Thoracic Surgery

Original article: cardiovascular
Coronary bypass surgery in women: a long-term comparative study of quality of life after bilateral internal mammary artery grafting in men and women

https://doi.org/10.1016/S0003-4975(02)03712-8Get rights and content

Abstract

Background. Coronary bypass surgery carries a higher operative mortality and less favorable long-term clinical benefits for women than men. The impact of arterial revascularization on long-term results, including quality of life (QOL) in women, compared with men, has not been clearly defined.

Methods. A retrospective analysis was performed comparing 261 consecutive women patients from a single surgical practice receiving bilateral internal mammary artery (IMA) and supplemental vein grafts between January 1972 and October 1994 with a computer-matched cohort of 261 men undergoing bilateral IMA surgery during the same time period. Univariate analysis confirmed the homogeneity of the two groups based on multiple preoperative variables. The SF-36 QOL assessment tool was completed for all patients at follow-up, which ranged from 1 month to 25 years, with a mean follow-up of 9.1 years for women and 8.6 years for men.

Results. There was no significant difference in operative mortality, nor in the incidence of any of 10 postoperative complications evaluated. The actuarial survival at 15 years was 53.7% ± 4.8% for women and 50.9% ± 5.6% for men (p = 0.218). At follow-up, 97.0% of women and 94.3% of men were free of angina and in Canadian Cardiovascular Society (CCS) class I or II. The need for reoperation (1.8% vs 1.9%) and PTCA (4.8% vs. 3.2%) was comparable in both groups. However, a higher rate of late myocardial infarction was found in women than men (1.8% vs 0.6, p = 0.021). The long-term event-free survival was found to be no different in men than women (p = 0.084). QOL as measured by the SF-36 was compared with the general population corrected for age and gender. Men and women scored as well or better than the general population in a majority of the eight health scales. Moreover, with regard to the health summary scores, men scored significantly higher (p = 0.001) in physical health, whereas women scored significantly higher (p = 0.011) in mental health when compared with age-adjusted norms.

Conclusions. Men and women undergoing coronary revascularization using bilateral internal mammary artery conduits experience comparable outcomes, excellent long-term results, and enjoy a QOL comparable to or better than the general population as measured by the SF-36.

Section snippets

Patient population

The study population consisted of two groups of computer-assisted matched patients. One cohort of 261 constitutes the entire group of women patients from this surgical practice who underwent coronary artery revascularization with bilateral IMA and supplemental vein grafts between January 1972 and October 1994. The other group contained 261 men from the same surgical practice who also underwent isolated bilateral IMA operations during the same time period. This cohort was selected from the total

Hospital morbidity rate

The overall incidence of postoperative morbidity for the two groups was low, with most patients in the female group 82.8% (n = 216) and 82.0% (n = 214) in the male group experiencing no hospital complications.

Respiratory insufficiency included patients who required intubation for more than 48 hours or tracheostomy (or both). Cerebrovascular accident referred to a neurological deficit that remained unresolved and presented for more than 24 hours. Myocardial infarction was defined as a new onset

Comment

Historically, the influence of gender has demonstrated that coronary surgery carries a higher operative mortality and reduced long-term prognosis in women compared with men 2, 4, 5. However, in the present study, a group of women receiving bilateral IMA grafts was compared with a matched cohort of male bilateral IMA patients. No significant difference was found in either operative mortality or morbidity.

Does this infer that the internal mammary graft may overcome the negative impact of female

Acknowledgements

We thank Dr Debra D. Guest and Starbuck Newton for technical assistance in the preparation of this manuscript.

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