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