03 Mar Women Remain At Higher Risk of Worse Outcome Following Coronary Bypass Surgery
MedicalResearch.com Interview with:
Dr. Gaudino
Mario FL Gaudino, MD, PhD, MSCE, FEBCTS, FACC, FAHA
Stephen and Suzanne Weiss Professor in Cardiothoracic Surgery (II)
Assistant Dean for Clinical Trials
Professor of Clinical Epidemiology and Health Services Research at Weill Cornell Graduate School
Director of the Joint Clinical Trials Office (JCTO)
Director of Translational and Clinical Research, Department of Cardiothoracic Surgery
Chair Coronary Artery Task Force, European Association for Cardio-Thoracic Surgery
Weill Cornell Medicine | NewYork – Presbyterian Hospital
Department of Cardiothoracic Surgery
MedicalResearch.com: What is the background for this study?
Response: It is well-documented that women undergoing CABG have higher mortality and morbidity when compared with men. They are referred to surgery later than men, with more cardiovascular risk factors than men, and present more frequently with heart failure or in non-elective settings. However, overall CABG outcomes have improved over time, and so we sought to evaluate national trends in outcomes specifically in women.
MedicalResearch.com: What are the main findings? Are women older, sicker, have more co-morbidities ie diabetes, obesity etc than men when they have heart surgery?
Response: Between 2011 and 2020, women had higher unadjusted mortality and higher unadjusted composite of mortality and morbidity after CABG than men. The attributable risk of female sex for operative mortality varied from 1.28 in 2011 to 1.41 in 2020, with no significant change over the study period. Also, women presented with significantly more comorbidity (such as diabetes, prior myocardial infarction, peripheral vascular disease, cerebrovascular disease), and with a higher need for urgent surgery, than men.
MedicalResearch.com: What should readers take away from your report?
Response: Women remain at higher risk of worse outcome following CABG, and there has been no improvement in outcomes for women over the last decade. We hope that this study is a call to action. We as physicians, cardiologists, and cardiothoracic surgeons need to do a better job in treating women undergoing cardiothoracic surgery- we cannot continue to simply apply the standard we use in men to women and hope for better results.
MedicalResearch.com: What recommendations do you have for future research as a results of this study?
Response: The reason for the differences in outcomes are very likely multifactorial, and all phases of care, from appropriate diagnosis and referral to surgery, as well as surgical technique and postoperative care, should be examined. Women make up only a small proportion of participants in cardiac surgery clinical trials, and results derived from overwhelmingly male study populations are applied to women. There should be concerted effort to enroll women in clinical trials or, better, to conduct trials specifically in women to provide data that can better inform clinical decision-making for women.
We have no disclosures to report.
Citation:
Gaudino M, Chadow D, Rahouma M, et al. Operative Outcomes of Women Undergoing Coronary Artery Bypass Surgery in the US, 2011 to 2020. JAMA Surg. Published online March 01, 2023. doi:10.1001/jamasurg.2022.8156
https://jamanetwork.com/journals/jamasurgery/article-abstract/2802105#:~:text=Unadjusted%20operative%20mortality%20in%20women,without%20significant%20improvement%20over%20time.
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