Influence of Sex and Race/ Ethnicity on Major Adverse Cardiovascular Outcomes Following Coronary Artery Bypass Surgery in a Large Integrated Healthcare System

  1. Janine Y. Yang
  2. Douglas Stram
  3. John Doan
  4. Alix P. Fairman
  5. Maqdooda Merchant
  6. Cynthia Triplett
  7. Ahmad Y. Sheikh
  8. Richard V. Ha
  9. Seema K. Pursnani
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Abstract

Background

We aimed to evaluate the influence of sex and race/ ethnicity on major adverse cardiovascular events (MACE) following coronary artery bypass grafting (CABG) in our integrated healthcare system.

Methods

This was a retrospective study of Kaiser Permanente Northern California members who underwent CABG from 2008-2019, evaluating odds of MACE (MI, stroke, serial percutaneous intervention (PCI), repeat CABG, death) at 30 days, 1 year, and up to 12 years follow-up using multivariable logistic and Cox proportional regression analyses. We adjusted for demographic, clinical, socioeconomic risk factors, and surgical characteristics.

Results

Cohort included n=7405, mean age 65.2 yrs, 47% diabetic, 62% hypertensive, 20% with prior revascularization (PCI or CABG). There were n=6082 males and n=1323 females with 2179 (35.8%) and 639 (48.3%) MACE, respectively. MACE occurred in 40.4% of White, 38.1% of Hispanic, 32.9% of Filipino, 27.9% of South Asian, 29.1% of Other Asian/ Pacific Islander, 47.0% of Black, and 42.3% of Other Race/ Ethnicity patients (p<0.001). Older age, higher HbA1c, diabetes, end-stage renal disease, lower hemoglobin, higher creatinine, smoking, lack of cardiopulmonary bypass, and use of non-arterial graft were significant predictors of long-term MACE. Female sex was associated with an increased odds of MACE at 30 days (OR 1.62, 95% CI, 1.19-2.21) and 1-year (HR 1.24, 95% CI, 1.02-1.51). Asian race/ ethnicity was associated with lower 12-year hazard of MACE (HR Filipino 0.72; 95% CI, 0.60-0.87; South Asian 0.72, 95% CI, 0.50-1.03; Other Asian 0.71, 95% CI, 0.58-0.87).

Conclusion

Female, Black, and Other Race/ Ethnicity groups had the greatest incidence of MACE at up to 12 years follow-up post CABG. These differences are largely driven by increased risk factor burden in these groups, and Black and Other race/ ethnicity were not independently associated with long-term CABG risk in multivariable modeling. Further understanding of the mechanisms for these sex and race/ethnic differences is required to improve upstream preventive efforts.

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