Sex-Related Differences in Outcomes of Coronary Artery Bypass Graft Surgery with Acute Coronary Syndromes: A Current Report from a Surgical Myocardial Infarction Registry

Background: While there is growing evidence that females have inferior outcomes and poorer prognosis after elective CABG compared with males, this relationship is poorly characterized in the setting of CABG for acute coronary syndromes (ACS). We therefore aimed to investigate sex differences in patients with ACS undergoing CABG on a multicenter basis in a large-scale registry.

Methods: Multicentric data were obtained from “The North-Rhine-Westphalia Surgical Myocardial Infarction Registry” with >120 patients characteristics and outcome variables. Primary study endpoint was in-hospital mortality (IHM). Secondary endpoints were cardiac-related death (CD), and major adverse cardiac and cerebrovascular events (MACCE) during index hospitalization. Multivariate logistic and non-parametric regression models were constructed to evaluate independent risk factors. Multivariate distributions of different groups were compared and the null hypothesis that underlying distributions are all equal was tested. A multiple testing procedure was incorporated to maintain the familywise error rate in the non-parametric model.

Results: Between 01/2010 and 03/2023, a total of 3,114 subjects with ACS were reported and entered. Patients were 67.4 ± 11 years of age, 685 (22%) females and 2,429 (78%) males, presenting ACS (UAP: 22.8%; NSTEMI: 51.6%; STEMI: 24%) with 46.2% left main disease, 82.3% triple-vessel disease, and a logEuroSCORE-I of 16.4 ± 17.2%. Baseline data and risk factors differed significantly between females and males: age (p = 0.0019), body height (P < 0.001), body weight (P < 0.001) as well as the logEuroSCORE-I (p = 0.0079). Female sex was associated with a significant increase of IHM (p < 0.02), CD (P < 0.02), and MACCE (P < 0.04) as compared with males. ACS subtype analysis showed that females consistently had higher rates of IHM, CD, and MACCE than males. Within ACS subtypes, females had a significantly higher IHM in UAP (p = 0.041), higher rates of CD in NSTEMI (p = 0.048), and a tendency toward higher MACCE rate in STEMI (p = 0.070). Multivariate logistic regression and non-parametric regression analyses identified female sex as an independent predictor of in-hospital mortality (p = 0.006), CD (p = 0.003), and MACCE (p = 0.026).

Conclusion: In this multicenter registry, even after adjustment by parametric and non-parametric multivariate regression models, female sex was associated with inferior CABG outcomes in terms of IHM, CD, and MACCE rates and was independently predictive in all subtypes of ACS.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
11 February 2025