title: Off-pump coronary artery bypass surgery in women.
abstract: OBJECTIVE
  Gender is a well-known risk factor for mortality and morbidity after coronary artery bypass grafting and various reasons have been proposed to explain the poorer results observed in women. The study objective was to determine whether female gender was still an operative risk factor with the adoption of off-pump coronary artery bypass surgery.
  
  
  METHODS
  Of 2123 consecutive patients who underwent isolated CABG between November 2002 and December 2007, 1966 (92.6%) (481 women and 1485 men) were operated without cardiopulmonary bypass and form the study population. Women were older (69.0 vs. 64.7 years; p = 0.001) and had more severe angina (CCS class 3.1 vs. 2.7; p = 0.001), smaller body surface area (1.6 vs. 1.8 m2; p = 0.001), higher body mass index and greater incidence of diabetes (48.3% vs. 34.2%; p = 0.005) than men. There were no statistically significant differences in the incidence of three-vessel disease (69.5% vs. 71.9%) or left main disease (22.2% vs. 27.0%) but ejection fraction was higher in women (61.3% vs. 59.0%; p = 0.01). Risk factors for in-hospital mortality were identified by univariate analysis and logistic regression.
  
  
  RESULTS
  The number of distal anastomoses was lower in women than in men (2.8 vs. 3.0; p = 0.001). In-hospital mortality was 2.0% in women and 0.8% in men (p = 0.01) and female gender was one of the eight risk factors for in-hospital mortality identified by univariate analysis. Using a logistic regression model, only age (OR: 1.7; 95% CI 1.01-1.14; p = 0.02) and logistic EuroSCORE (OR: 1.07; 95% CI 1.03-1.10; p < 0.001) were independently associated with in-hospital mortality. Logistic EuroSCORE was the only independent risk factor for major morbidity (OR: 1.07 95% CI 1.04-1.10; p < 0.001).
  
  
  CONCLUSIONS
  Women who undergo coronary artery bypass grafting have an unfavorable clinical profile compared to men, resulting in higher unadjusted in-hospital mortality. However, in an unselected patient population undergoing off-pump CABG, female gender was not found to be an independent risk factor for mortality or major morbidity.
authors.affiliation: Departamento da Circulação, Hospital da Cruz Vermelha Portuguesa, Lisboa, Portugal. miguel.uva@hcvp.com.pt
authors.forename: Miguel Sousa
authors.initials: MS
authors.lastname: Uva
authors.forename: Sónia
authors.initials: S
authors.lastname: Freitas
authors.forename: Albino
authors.initials: A
authors.lastname: Pedro
authors.forename: Fernando
authors.initials: F
authors.lastname: Matias
authors.forename: Armindo
authors.initials: A
authors.lastname: Mesquita
authors.forename: José
authors.initials: J
authors.lastname: Bau
authors.forename: João
authors.initials: J
authors.lastname: Pinho
authors.forename: Judite
authors.initials: J
authors.lastname: Fernandes
authors.forename: Manuel Pedro
authors.initials: MP
authors.lastname: Magalhães
mesh_terms: D000368:Aged; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects* / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors