Gender Disparities Among Multi-Arterial Coronary Bypass Grafting 公开

Hunting, John Crawford (2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/zw12z627m?locale=zh
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Abstract

Gender Disparities among Multiple Arterial Coronary Bypass Grafting

By John Hunting

Introduction

Coronary artery bypass grafting (CABG) is the primary surgical method of intervention for advanced coronary artery disease (CAD). CAD is one of the leading causes of mortality in the USA, the need to improve this intervention is great. An emerging technique for CABG is multiple arterial grafting, or the use of multiple arteries, and is currently preformed much less frequently than single arterial despite some evidence for improved long term survival. This study set out to investigate if there was any association between multiple arterial grafting, gender, and short term/long term outcomes.

Methods

This study was a prospective case control study of 20385 Emory patients who underwent isolated CABG with 2 or more grafts. Emergent salvage patients were excluded from this analysis. Statistical methods included univariate and bivariate analysis to assess risk factors, logistic regression and Cox survival models to assess relevant outcomes, and investigations into internal study validity. Significance testing was conducted at the 95% confidence level.

Results

This study concluded that women received multiple arterial grafting half as often as men (10.83% vs 20.50%) even when controlling for PROM. Multiple arterial CABG provided improved 30-day mortality, and improved long term survival among all participants (HR=0.76) Females had significantly shorter 30-day and long-term survival than their male counterparts. Among multi-arterial patients, the difference in risk between genders was insignificant (HRfemale =1.26, 95% CI [0.99, 1.61]).

Conclusion

This study has a three-part conclusion. First, females are at a higher risk of adverse outcomes from CABG. Second, multiple arterial grafting improves both short term and long term survival of both women and men in similar magnitude. Third, despite these improved short term and long term outcomes, females receive CABG only half as often as their equivalent male counterparts. Along with the need of awareness and shift in surgical methods, further research needs to be done into why this disparity exists, if there are other domains with similar disparities, and if more can be done to enhance the survival of female patients.

Table of Contents

Table of Contents

Title page - pg 3.

Abstract - pg 6.

Chapter I: Literature review - pg 9.

Chapter II: Manuscript - pg 16.

Introduction - pg 17.

Methods - pg 20.

Results - pg 23.

Discussion - pg 28.

References - pg 32.

Tables - pg 34.

Figures - pg 40.

Chapter III: Future directions - pg 43.

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