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Off-pump techniques benefit men and women and narrow the disparity in mortality after coronary bypass grafting.
Ann Thorac Surg. 2007 Nov; 84(5):1447-54; discussion 1454-6.AT

Abstract

BACKGROUND

Women have historically had greater morbidity and mortality than men after conventional coronary artery bypass grafting (CABG) on cardiopulmonary bypass (ONCAB). It is controversial whether off-pump CABG (OPCAB) alters this gender-based disparity.

METHODS

The Society of Thoracic Surgeons National Cardiac Database was reviewed for risk factors and clinical outcomes of 42,477 consecutive, nonemergency, isolated, primary ONCAB or OPCAB cases performed at 63 North American centers that performed more than 100 OPCAB cases between January 1, 2004, and December 31, 2005. Odds ratios for adverse events, adjusted for 32 clinical and demographic covariates, were compared by multiple logistic regression models between women and men who had OPCAB versus ONCAB. All analyses were by intention-to-treat; 355 (2.2%) patients converted from OPCAB to ONCAB intraoperatively were included in the OPCAB group.

RESULTS

Women (n = 11,785) and those treated with OPCAB (n = 16,245) were older and had more comorbidities than men (n = 30,662) and those treated with conventional ONCAB (n = 26,202). Overall, adjusted odds ratios for death and most major complications in both men and women were significantly lower with OPCAB than with ONCAB. Among ONCAB cases only, women had a significantly greater adjusted risk of death, prolonged ventilation, and long length of stay than men. In contrast, among OPCAB cases, women had lower risk of reexploration than men and similar risks for death, myocardial infarction, and prolonged ventilation and hospital stay.

CONCLUSIONS

OPCAB is associated with lower adjusted risk of death and major adverse events than ONCAB. OPCAB benefits both men and women and reduces the gender disparity in clinical outcomes after CABG.

Authors+Show Affiliations

Emory University School of Medicine, Atlanta, Georgia 30308, USA. john.puskas@emoryhealthcare.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17954045

Citation

Puskas, John D., et al. "Off-pump Techniques Benefit Men and Women and Narrow the Disparity in Mortality After Coronary Bypass Grafting." The Annals of Thoracic Surgery, vol. 84, no. 5, 2007, pp. 1447-54; discussion 1454-6.
Puskas JD, Edwards FH, Pappas PA, et al. Off-pump techniques benefit men and women and narrow the disparity in mortality after coronary bypass grafting. Ann Thorac Surg. 2007;84(5):1447-54; discussion 1454-6.
Puskas, J. D., Edwards, F. H., Pappas, P. A., O'Brien, S., Peterson, E. D., Kilgo, P., & Ferguson, T. B. (2007). Off-pump techniques benefit men and women and narrow the disparity in mortality after coronary bypass grafting. The Annals of Thoracic Surgery, 84(5), 1447-54; discussion 1454-6.
Puskas JD, et al. Off-pump Techniques Benefit Men and Women and Narrow the Disparity in Mortality After Coronary Bypass Grafting. Ann Thorac Surg. 2007;84(5):1447-54; discussion 1454-6. PubMed PMID: 17954045.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Off-pump techniques benefit men and women and narrow the disparity in mortality after coronary bypass grafting. AU - Puskas,John D, AU - Edwards,Fred H, AU - Pappas,Paul A, AU - O'Brien,Sean, AU - Peterson,Eric D, AU - Kilgo,Patrick, AU - Ferguson,T Bruce,Jr PY - 2007/01/30/received PY - 2007/06/06/revised PY - 2007/06/07/accepted PY - 2007/10/24/pubmed PY - 2007/11/9/medline PY - 2007/10/24/entrez SP - 1447-54; discussion 1454-6 JF - The Annals of thoracic surgery JO - Ann Thorac Surg VL - 84 IS - 5 N2 - BACKGROUND: Women have historically had greater morbidity and mortality than men after conventional coronary artery bypass grafting (CABG) on cardiopulmonary bypass (ONCAB). It is controversial whether off-pump CABG (OPCAB) alters this gender-based disparity. METHODS: The Society of Thoracic Surgeons National Cardiac Database was reviewed for risk factors and clinical outcomes of 42,477 consecutive, nonemergency, isolated, primary ONCAB or OPCAB cases performed at 63 North American centers that performed more than 100 OPCAB cases between January 1, 2004, and December 31, 2005. Odds ratios for adverse events, adjusted for 32 clinical and demographic covariates, were compared by multiple logistic regression models between women and men who had OPCAB versus ONCAB. All analyses were by intention-to-treat; 355 (2.2%) patients converted from OPCAB to ONCAB intraoperatively were included in the OPCAB group. RESULTS: Women (n = 11,785) and those treated with OPCAB (n = 16,245) were older and had more comorbidities than men (n = 30,662) and those treated with conventional ONCAB (n = 26,202). Overall, adjusted odds ratios for death and most major complications in both men and women were significantly lower with OPCAB than with ONCAB. Among ONCAB cases only, women had a significantly greater adjusted risk of death, prolonged ventilation, and long length of stay than men. In contrast, among OPCAB cases, women had lower risk of reexploration than men and similar risks for death, myocardial infarction, and prolonged ventilation and hospital stay. CONCLUSIONS: OPCAB is associated with lower adjusted risk of death and major adverse events than ONCAB. OPCAB benefits both men and women and reduces the gender disparity in clinical outcomes after CABG. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/17954045/Off_pump_techniques_benefit_men_and_women_and_narrow_the_disparity_in_mortality_after_coronary_bypass_grafting_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(07)01825-5 DB - PRIME DP - Unbound Medicine ER -