CHICAGO — Off-pump coronary bypass produced outcomes in women that closely tracked the off-pump results in men.
In other words, performing coronary artery bypass graft surgery (CABG) off pump “narrowed the gender-based disparity in outcomes” that occurs with conventional, on-pump bypass surgery, based on a review of more than 11,000 procedures done at Emory University in Atlanta since 1997, Dr. John D. Puskas said at the annual scientific sessions of the American Heart Association.
The finding that off-pump bypass was especially beneficial in women confirmed a previously reported result from an analysis of U.S. data on bypass outcomes collected by the Society of Thoracic Surgeons. The agreement of the two findings means that cardiac surgeons can conclude with confidence that “we should do more off-pump bypass surgery, especially in women,” said Dr. Puskas, associate chief of cardiothoracic surgery at Emory.
The Emory study involved 11,413 consecutive patients who underwent CABG surgery during January 1997-May 2005. The only patients excluded were those who had a redo bypass procedure, and those who had another type of concurrent surgery, such as valve replacement. The group included 3,248 women (28%) and 8,165 men (72%). Off-pump bypass was done in 4,492 patients (39%), of whom 1,381 were women.
Overall, off-pump surgery resulted in reduced rates of death, 1.4%, compared with a 2.4% rate with conventional bypass surgery; stroke, 1.2%, compared with 2.0%; and total major adverse events, 2.9%, compared with 4.8%
Among women, actual mortality following off-pump bypass was cut by 54%, compared with expected mortality. This substantial beneficial effect of off-pump surgery contrasted with conventional bypass, which was linked to a 38% increase in the actual rate of death among women, compared with the expected rate (see box). Men also showed a benefit from off-pump surgery, but the drop in expected deaths was not nearly as dramatic as it was in women.
Women who underwent off-pump bypass had a risk-adjusted 29% reduced risk for death, compared with men, and a 4% reduced risk for all major adverse coronary events. Statistically, the rate of these and all other complications was no different in women and men.
In contrast, women treated with conventional bypass had a risk-adjusted 60% higher rate of death, and a 71% higher rate of all major adverse events, compared with men, documenting the statistically significant difference in the rate of bad outcomes in women, compared with men.
Off-pump bypass has now become routine at Emory, but nationally in the United States it remains underused, said Dr. Puskas. In 1997, when off-pump bypass began at Emory, 10%–20% of CABG surgeries were done off pump. But off-pump use gradually rose, and by 2005, the most recent year with full data available, 80% of all bypass surgeries at Emory were done off pump, he said in an interview. But nationwide, 22% of all bypass surgery in 2005 was done off pump, according to the data collected by the Society of Thoracic Surgeons, Dr. Puskas said.
The findings confirm that 'we should do more off-pump bypass surgery, especially in women.' DR. PUSKAS
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