Thorac Cardiovasc Surg 2014; 62 - OP2
DOI: 10.1055/s-0034-1367082

No risk of female sex in a randomized population of patients undergoing coronary bypass surgery

G. Färber 1, M. Zacher 2, T. Doenst 1, T. Sandhaus 1, M. Diab 1, W. Reents 2, M. Breuer 1, J. Börgermann 3, U. Kappert 4, A. Böning 5 A. Diegeler 2for the GOPCABE-Investigators
  • 1Jena University Hospital - Friedrich-Schiller-University of Jena, Department of Cardiothoracic Surgery, Jena, Germany
  • 2Cardiovascular Clinic Bad Neustadt, Clinic for Cardiac Surgery, Bad Neustadt / Saale, Germany
  • 3Heart and Diabetes Centre NRW, Ruhr University Bochum, Clinic for Heart, Thoracic and Cardiovascular Surgery, Bad Oeynhausen, Germany
  • 4Cardiovascular Institute, University of Dresden, Department of Cardiac Surgery, Dresden, Germany
  • 5University of Giessen, Department of Cardiovascular Surgery, Giessen, Germany

Objective: Female sex is a commonly accepted risk factor in coronary artery bypass surgery that finds application in popular risk scores. The Euroscore uses an odds ratio for women vs. men of 1.3915 and the German Coronary Surgery Score (KCH) uses an odds ratio of up to 4.44 (increasing with age). The German Off-Pump Coronary Artery Bypass grafting in the Elderly (GOPCABE)-Trial reported no benefit for off-pump vs. on-pump surgery in patients above 75 years of age (n = 2394). About one third of them (n = 755) were female.

Methods: In this sub-analysis of the GOPCABE-Trial we tested the hypothesis that women would benefit from off-pump surgery compared to men and analyzed whether the anticipated increased risk of female sex was also present in this patient population.

Results: Sex specific comparisons of on- and off-pump surgery using logistic regression analyses did not reveal significant effects of either operative technique on mortality. In men, the odds ratio (OR) for on-pump (n = 818) versus off-pump (n = 821) was 0.90 (95%-CI: [0.63;1.27]). In women, the OR for on-pump (n = 389) versus off-pump (n = 366) was 1.07 (95%-CI: [0.62;1.87]). For the lack of sex-specific differences between on- and off-pump, groups were combined for further analyses. For the entire GOPCABE population, women had significantly higher Euroscores (8.88 ± 6.71 versus 7.99 ± 6.69; p = 0.003) and KCH-scores (4.42 ± 3.97 versus 3.57 ± 3.65; p = 0.001). There were no relevant differences in perioperative variables (e.g., number of distal anastomoses). Contrary to expectations, there was a trend towards a lower risk associated with female sex when assessing perioperative death (OR 0.69; 95%-CI: [0.39;1.22]) or a combined endpoint of death, myocardial infarction, stroke, re-revascularisation or renal replacement therapy (OR 0.80; 95%-CI: [0.57;1.12]).

Conclusions: The results from this patient population suggest that, in contrast to common belief, female sex does not appear to be a risk factor in coronary bypass surgery. However, this unexpected result is not related to the surgical technique of revascularisation.