title: Gender-specific predictors of early mortality after coronary artery bypass graft surgery.
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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Lehmkuhl
authors.forename: F
authors.initials: F
authors.lastname: Kendel
authors.forename: G
authors.initials: G
authors.lastname: Gelbrich
authors.forename: A
authors.initials: A
authors.lastname: Dunkel
authors.forename: S
authors.initials: S
authors.lastname: Oertelt-Prigione
authors.forename: B
authors.initials: B
authors.lastname: Babitsch
authors.forename: C
authors.initials: C
authors.lastname: Knosalla
authors.forename: N
authors.initials: N
authors.lastname: Bairey-Merz
authors.forename: R
authors.initials: R
authors.lastname: Hetzer
authors.forename: V
authors.initials: V
authors.lastname: Regitz-Zagrosek
mesh_terms: D000367:Age Factors; D000368:Aged; D002303:Cardiac Output, Low / Q000453:epidemiology*; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality*; D005260:Female; D005858:Germany; D006333:Heart Failure / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000453:epidemiology*; D012151:Resuscitation / Q000379:methods; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors