Gender-specific predictors of early mortality after coronary artery bypass graft surgery
Background Female gender is a risk factor for early mortality after coronary artery bypass graft surgery (CABG). Yet, the causes for this excess mortality in women have not been fully explained. Objectives To analyse gender differences in early mortality (30 days post surgery) after CABG and to iden...
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| Veröffentlicht in: | Clinical research in cardiology 2012-09, Vol.101 (9), p.745-751 |
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| creator | Lehmkuhl, E. Kendel, F. Gelbrich, G. Dunkel, A. Oertelt-Prigione, S. Babitsch, B. Knosalla, C. Bairey-Merz, N. Hetzer, R. Regitz-Zagrosek, V. |
| description | Background
Female gender is a risk factor for early mortality after coronary artery bypass graft surgery (CABG). Yet, the causes for this excess mortality in women have not been fully explained.
Objectives
To analyse gender differences in early mortality (30 days post surgery) after CABG and to identify variables explaining the association between female gender and excess mortality, taking into account preoperative clinical and psychosocial, surgical and postoperative risk factors.
Methods
A total of 1,559 consecutive patients admitted to the German Heart Institute Berlin (2005–2008) for CABG were included in this prospective study. A comprehensive set of prespecified preoperative, surgical and postoperative risk factors were examined for their ability to explain the gender difference in early mortality.
Results
Early mortality after CABG was higher in women than in men (6.9 vs. 2.4 %, HR 2.91, 95 % CI 1.70–4.96,
P
|
| doi_str_mv | 10.1007/s00392-012-0454-0 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1035107459</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2748866691</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-df8a200ec65abb008aa312f8976e72b68fe522f570431a3d125fc5d45a2be3d53</originalsourceid><addsrcrecordid>eNp1kEFLwzAUgIMobk5_gBcJePFSfUmbpj3K0CkMvCh4K2majI6uqUl76L_3jc4hgoeQvLzvveR9hFwzuGcA8iEAxDmPgOFKRBLBCZmzLGURpDk_PZ6zZEYuQtgCCAZxck5mnAsuIWdz8rkybWV8FDqja1tr2nlT1bp3PlBnqVG-GenO-V41dT9SZXvjqXbetcpj6DEcaTl2KgS68ZimYfAbvLwkZ1Y1wVwd9gX5eH56X75E67fV6_JxHelY8j6qbKY4gNGpUGUJkCkVM26zXKZG8jLNrBGcWyEhiZmKK8aF1aJKhOKliSsRL8jd1Lfz7mswoS92ddCmaVRr3BAKnBinlonIEb39g27d4Fv83Z6SaITLDCk2Udq7ELyxRefrHU6LULHXXkzaC9Re7LUXgDU3h85DuTPVseLHMwJ8AgKmWvTz--n_un4DDRiNYQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1037270278</pqid></control><display><type>article</type><title>Gender-specific predictors of early mortality after coronary artery bypass graft surgery</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Lehmkuhl, E. ; Kendel, F. ; Gelbrich, G. ; Dunkel, A. ; Oertelt-Prigione, S. ; Babitsch, B. ; Knosalla, C. ; Bairey-Merz, N. ; Hetzer, R. ; Regitz-Zagrosek, V.</creator><creatorcontrib>Lehmkuhl, E. ; Kendel, F. ; Gelbrich, G. ; Dunkel, A. ; Oertelt-Prigione, S. ; Babitsch, B. ; Knosalla, C. ; Bairey-Merz, N. ; Hetzer, R. ; Regitz-Zagrosek, V.</creatorcontrib><description>Background
Female gender is a risk factor for early mortality after coronary artery bypass graft surgery (CABG). Yet, the causes for this excess mortality in women have not been fully explained.
Objectives
To analyse gender differences in early mortality (30 days post surgery) after CABG and to identify variables explaining the association between female gender and excess mortality, taking into account preoperative clinical and psychosocial, surgical and postoperative risk factors.
Methods
A total of 1,559 consecutive patients admitted to the German Heart Institute Berlin (2005–2008) for CABG were included in this prospective study. A comprehensive set of prespecified preoperative, surgical and postoperative risk factors were examined for their ability to explain the gender difference in early mortality.
Results
Early mortality after CABG was higher in women than in men (6.9 vs. 2.4 %, HR 2.91, 95 % CI 1.70–4.96,
P
< 0.001). Women were older than men (+4.7 years,
P
< 0.001), had lower self-assessed preoperative physical functioning (−16 points on a scale from 0 to 100,
P
< 0.001), and had higher rates of postoperative low cardiac output syndromes (6.6 vs. 3.3 %,
P
= 0.01), respiratory insufficiency (9.4 vs. 5.3 %,
P
= 0.006) and resuscitation (5.2 vs. 1.8 %,
P
= 0.001). The combination of these factors explained 71 % of the gender difference in early mortality; age and physical functioning alone accounted for 61 %. Adjusting for these variables, HR for female gender was 1.36 (95 % CI 0.77–2.41,
P
= 0.29).
Conclusions
Age, physical function and postoperative complications are key mediators of the overmortality of women after aortocoronary bypass surgery. Self-assessed physical functioning should be more seriously considered in preoperative risk assessment particularly in women.</description><identifier>ISSN: 1861-0684</identifier><identifier>EISSN: 1861-0692</identifier><identifier>DOI: 10.1007/s00392-012-0454-0</identifier><identifier>PMID: 22527091</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer-Verlag</publisher><subject>Age Factors ; Aged ; Cardiac Output, Low - epidemiology ; Cardiology ; Coronary Artery Bypass - methods ; Coronary Artery Bypass - mortality ; Female ; Germany ; Heart Failure - surgery ; Humans ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Original Paper ; Proportional Hazards Models ; Prospective Studies ; Respiratory Insufficiency - epidemiology ; Resuscitation - methods ; Risk Factors ; Sex Factors ; Time Factors</subject><ispartof>Clinical research in cardiology, 2012-09, Vol.101 (9), p.745-751</ispartof><rights>Springer-Verlag 2012</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-df8a200ec65abb008aa312f8976e72b68fe522f570431a3d125fc5d45a2be3d53</citedby><cites>FETCH-LOGICAL-c372t-df8a200ec65abb008aa312f8976e72b68fe522f570431a3d125fc5d45a2be3d53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00392-012-0454-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00392-012-0454-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22527091$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lehmkuhl, E.</creatorcontrib><creatorcontrib>Kendel, F.</creatorcontrib><creatorcontrib>Gelbrich, G.</creatorcontrib><creatorcontrib>Dunkel, A.</creatorcontrib><creatorcontrib>Oertelt-Prigione, S.</creatorcontrib><creatorcontrib>Babitsch, B.</creatorcontrib><creatorcontrib>Knosalla, C.</creatorcontrib><creatorcontrib>Bairey-Merz, N.</creatorcontrib><creatorcontrib>Hetzer, R.</creatorcontrib><creatorcontrib>Regitz-Zagrosek, V.</creatorcontrib><title>Gender-specific predictors of early mortality after coronary artery bypass graft surgery</title><title>Clinical research in cardiology</title><addtitle>Clin Res Cardiol</addtitle><addtitle>Clin Res Cardiol</addtitle><description>Background
Female gender is a risk factor for early mortality after coronary artery bypass graft surgery (CABG). Yet, the causes for this excess mortality in women have not been fully explained.
Objectives
To analyse gender differences in early mortality (30 days post surgery) after CABG and to identify variables explaining the association between female gender and excess mortality, taking into account preoperative clinical and psychosocial, surgical and postoperative risk factors.
Methods
A total of 1,559 consecutive patients admitted to the German Heart Institute Berlin (2005–2008) for CABG were included in this prospective study. A comprehensive set of prespecified preoperative, surgical and postoperative risk factors were examined for their ability to explain the gender difference in early mortality.
Results
Early mortality after CABG was higher in women than in men (6.9 vs. 2.4 %, HR 2.91, 95 % CI 1.70–4.96,
P
< 0.001). Women were older than men (+4.7 years,
P
< 0.001), had lower self-assessed preoperative physical functioning (−16 points on a scale from 0 to 100,
P
< 0.001), and had higher rates of postoperative low cardiac output syndromes (6.6 vs. 3.3 %,
P
= 0.01), respiratory insufficiency (9.4 vs. 5.3 %,
P
= 0.006) and resuscitation (5.2 vs. 1.8 %,
P
= 0.001). The combination of these factors explained 71 % of the gender difference in early mortality; age and physical functioning alone accounted for 61 %. Adjusting for these variables, HR for female gender was 1.36 (95 % CI 0.77–2.41,
P
= 0.29).
Conclusions
Age, physical function and postoperative complications are key mediators of the overmortality of women after aortocoronary bypass surgery. Self-assessed physical functioning should be more seriously considered in preoperative risk assessment particularly in women.</description><subject>Age Factors</subject><subject>Aged</subject><subject>Cardiac Output, Low - epidemiology</subject><subject>Cardiology</subject><subject>Coronary Artery Bypass - methods</subject><subject>Coronary Artery Bypass - mortality</subject><subject>Female</subject><subject>Germany</subject><subject>Heart Failure - surgery</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Original Paper</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Respiratory Insufficiency - epidemiology</subject><subject>Resuscitation - methods</subject><subject>Risk Factors</subject><subject>Sex Factors</subject><subject>Time Factors</subject><issn>1861-0684</issn><issn>1861-0692</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kEFLwzAUgIMobk5_gBcJePFSfUmbpj3K0CkMvCh4K2majI6uqUl76L_3jc4hgoeQvLzvveR9hFwzuGcA8iEAxDmPgOFKRBLBCZmzLGURpDk_PZ6zZEYuQtgCCAZxck5mnAsuIWdz8rkybWV8FDqja1tr2nlT1bp3PlBnqVG-GenO-V41dT9SZXvjqXbetcpj6DEcaTl2KgS68ZimYfAbvLwkZ1Y1wVwd9gX5eH56X75E67fV6_JxHelY8j6qbKY4gNGpUGUJkCkVM26zXKZG8jLNrBGcWyEhiZmKK8aF1aJKhOKliSsRL8jd1Lfz7mswoS92ddCmaVRr3BAKnBinlonIEb39g27d4Fv83Z6SaITLDCk2Udq7ELyxRefrHU6LULHXXkzaC9Re7LUXgDU3h85DuTPVseLHMwJ8AgKmWvTz--n_un4DDRiNYQ</recordid><startdate>20120901</startdate><enddate>20120901</enddate><creator>Lehmkuhl, E.</creator><creator>Kendel, F.</creator><creator>Gelbrich, G.</creator><creator>Dunkel, A.</creator><creator>Oertelt-Prigione, S.</creator><creator>Babitsch, B.</creator><creator>Knosalla, C.</creator><creator>Bairey-Merz, N.</creator><creator>Hetzer, R.</creator><creator>Regitz-Zagrosek, V.</creator><general>Springer-Verlag</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20120901</creationdate><title>Gender-specific predictors of early mortality after coronary artery bypass graft surgery</title><author>Lehmkuhl, E. ; Kendel, F. ; Gelbrich, G. ; Dunkel, A. ; Oertelt-Prigione, S. ; Babitsch, B. ; Knosalla, C. ; Bairey-Merz, N. ; Hetzer, R. ; Regitz-Zagrosek, V.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-df8a200ec65abb008aa312f8976e72b68fe522f570431a3d125fc5d45a2be3d53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Age Factors</topic><topic>Aged</topic><topic>Cardiac Output, Low - epidemiology</topic><topic>Cardiology</topic><topic>Coronary Artery Bypass - methods</topic><topic>Coronary Artery Bypass - mortality</topic><topic>Female</topic><topic>Germany</topic><topic>Heart Failure - surgery</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Original Paper</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><topic>Respiratory Insufficiency - epidemiology</topic><topic>Resuscitation - methods</topic><topic>Risk Factors</topic><topic>Sex Factors</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lehmkuhl, E.</creatorcontrib><creatorcontrib>Kendel, F.</creatorcontrib><creatorcontrib>Gelbrich, G.</creatorcontrib><creatorcontrib>Dunkel, A.</creatorcontrib><creatorcontrib>Oertelt-Prigione, S.</creatorcontrib><creatorcontrib>Babitsch, B.</creatorcontrib><creatorcontrib>Knosalla, C.</creatorcontrib><creatorcontrib>Bairey-Merz, N.</creatorcontrib><creatorcontrib>Hetzer, R.</creatorcontrib><creatorcontrib>Regitz-Zagrosek, V.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical research in cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lehmkuhl, E.</au><au>Kendel, F.</au><au>Gelbrich, G.</au><au>Dunkel, A.</au><au>Oertelt-Prigione, S.</au><au>Babitsch, B.</au><au>Knosalla, C.</au><au>Bairey-Merz, N.</au><au>Hetzer, R.</au><au>Regitz-Zagrosek, V.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Gender-specific predictors of early mortality after coronary artery bypass graft surgery</atitle><jtitle>Clinical research in cardiology</jtitle><stitle>Clin Res Cardiol</stitle><addtitle>Clin Res Cardiol</addtitle><date>2012-09-01</date><risdate>2012</risdate><volume>101</volume><issue>9</issue><spage>745</spage><epage>751</epage><pages>745-751</pages><issn>1861-0684</issn><eissn>1861-0692</eissn><abstract>Background
Female gender is a risk factor for early mortality after coronary artery bypass graft surgery (CABG). Yet, the causes for this excess mortality in women have not been fully explained.
Objectives
To analyse gender differences in early mortality (30 days post surgery) after CABG and to identify variables explaining the association between female gender and excess mortality, taking into account preoperative clinical and psychosocial, surgical and postoperative risk factors.
Methods
A total of 1,559 consecutive patients admitted to the German Heart Institute Berlin (2005–2008) for CABG were included in this prospective study. A comprehensive set of prespecified preoperative, surgical and postoperative risk factors were examined for their ability to explain the gender difference in early mortality.
Results
Early mortality after CABG was higher in women than in men (6.9 vs. 2.4 %, HR 2.91, 95 % CI 1.70–4.96,
P
< 0.001). Women were older than men (+4.7 years,
P
< 0.001), had lower self-assessed preoperative physical functioning (−16 points on a scale from 0 to 100,
P
< 0.001), and had higher rates of postoperative low cardiac output syndromes (6.6 vs. 3.3 %,
P
= 0.01), respiratory insufficiency (9.4 vs. 5.3 %,
P
= 0.006) and resuscitation (5.2 vs. 1.8 %,
P
= 0.001). The combination of these factors explained 71 % of the gender difference in early mortality; age and physical functioning alone accounted for 61 %. Adjusting for these variables, HR for female gender was 1.36 (95 % CI 0.77–2.41,
P
= 0.29).
Conclusions
Age, physical function and postoperative complications are key mediators of the overmortality of women after aortocoronary bypass surgery. Self-assessed physical functioning should be more seriously considered in preoperative risk assessment particularly in women.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer-Verlag</pub><pmid>22527091</pmid><doi>10.1007/s00392-012-0454-0</doi><tpages>7</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1861-0684 |
| ispartof | Clinical research in cardiology, 2012-09, Vol.101 (9), p.745-751 |
| issn | 1861-0684 1861-0692 |
| language | eng |
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| source | MEDLINE; SpringerNature Journals |
| subjects | Age Factors Aged Cardiac Output, Low - epidemiology Cardiology Coronary Artery Bypass - methods Coronary Artery Bypass - mortality Female Germany Heart Failure - surgery Humans Male Medicine Medicine & Public Health Middle Aged Original Paper Proportional Hazards Models Prospective Studies Respiratory Insufficiency - epidemiology Resuscitation - methods Risk Factors Sex Factors Time Factors |
| title | Gender-specific predictors of early mortality after coronary artery bypass graft surgery |
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