Gender and coronary artery bypass grafting in cardiogenic shock
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ORIGINAL ARTICLE
Gender and coronary artery bypass grafting in cardiogenic shock Marcin P. Szczechowicz 1
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& Sabreen Mkalaluh & Saeed Torabi & Jerry Easo & Matthias Karck & Alexander Weymann
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Received: 15 January 2020 / Revised: 31 May 2020 / Accepted: 5 June 2020 # Indian Association of Cardiovascular-Thoracic Surgeons 2020
Abstract Purpose Bypass surgery in patients undergoing cardiogenic shock caused by acute coronary syndrome is one of the most urgent and often performed cardiac operations. It remains unclear if patients gender independently influences the outcome. Literature reveals that females and males primarily differ from each other with regard to many important preoperative characteristics. Our objective was to compare the outcome and postoperative courses of both genders, using matched samples, eliminating these preoperative differences. Methods Between 2007 and 2015, 491 patients in cardiogenic shock underwent urgent bypass surgery in our institution. To assess the impact of gender on outcomes, we performed a propensity score matching to create two groups [males and females] which were matched for age, severity of shock, coronary artery disease morphology, and other comorbidities. Two groups were created: (1) 103 female and (2) 103 male patients. We analyzed the outcomes, complications and potential mortality predictors. Results Most of the patients had three-vessel disease (70.1%, n = 344) with proximal left anterior descending lesion (88%, n = 432). Our study showed no differences between female and male patients regarding choice of conduits, number of anastomosed vessels, and outcome. Acute kidney injury (AKI) occurred significantly more often in female patients and pericardial tamponade in their male counterparts. There were no differences regarding other major complications. Conclusion Gender does not appear to influence long-term outcomes in the study sample. Female gender is an independent risk factor for postoperative AKI. Other complications occurred with comparable rates in both genders. Exertion tolerance in the follow-up period was similar between genders. Keywords Coronary artery bypass grafting . Acute coronary syndrome . Cardiogenic shock . Gender differences
Introduction Cardiogenic shock (CS) is a life-threatening state of reduced cardiac output; it results in hypotension and impaired endorgan perfusion caused by primary cardiac disorders [1]. Acute coronary syndrome (ACS) is the underlying pathology in about 80% of cases [2]. Occurring in about 5 to 10% of all ACS patients, CS is the main cause of early mortality in this group with an in-hospital mortality rate of up to 51% [1, 3].
* Marcin P. Szczechowicz [email protected] 1
Department of Cardiac Surgery, Heart and Marfan Center, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
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Essen Huttrop Heart Center, Herwarthstrasse100, 45138 Essen, Germany
This rate would be higher if the patients were treated only medically, but causal therapy with early revascularization or mech
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