Detection of gender differences in incomplete revascularization after coronary artery bypass surgery varies with classification technique

  • Background. Incomplete revascularization negatively affects survival after coronary artery bypass surgery (CABG). Since gender and classification technique might impact outcome and reporting, we investigated their effect on revascularization patterns and mortality. Methods. A cohort of bypass patients (N = 1545, 23% women) was enrolled prospectively. The degree of revascularization was determined as mathematical difference between affected vessels upon diagnosis and number of grafts or the surgeon’s rating on the case file. Results. Although men displayed more triple-vessel disease, they obtained complete revascularization more frequently than women (85% versus 77%, P < 0.001). The two calculation methods identified analogous percentages of incompletely revascularized patients, yet there was only a 50% overlap between the two groups. Mathematically, more women, older patients, and patients with NYHA class III/IV appeared incompletely revascularized, while the surgeons identified more patients undergoing technically challenging procedures. Regardless of the definition, incompleteness was a significant risk factor for mortality in both genders (mathematical calculation: HR 2.62, 95% CI 1.76–3.89, P < 0.001; surgeon: HR 2.04, 95% CI 1.35–3.89, P = 0.001). Conclusions. Given the differences in identification patterns, we advise that the mathematical calculation be performed after-procedure in all patients regardless of the surgeons’ rating to uncover additional subjects at increased risk.

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Author:Sabine Oertelt-PrigioneORCiDGND, Friederike KendelORCiDGND, Martin KaltenbachGND, Roland HetzerORCiDGND, Vera Regitz-ZagrosekORCiDGND, Rufus BarettiORCiDGND
Parent Title (English):BioMed Research International
Publisher:Hindawi Publishing Corporation
Document Type:Article
Date of Publication (online):2013/07/08
Date of first Publication:2013/07/08
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2020/06/17
Issue:Article ID 108475
Page Number:8
Institutes:Medizin / Medizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - Namensnennung 4.0