Combined coronary artery bypass with carotid endarterectomy: do women have worse outcomes?

OBJECTIVE: Women undergoing coronary artery bypass grafting (CABG) have higher mortality and morbidity in numerous studies. Although controversial, similar results have been seen in women undergoing carotid endarterectomy. We examined the results of combined eversion CEA/CABG by one group to analyze if the outcome is different between men and women in this setting.

METHOD: The records of all patients undergoing combined eversion CEA/CABG were reviewed from our vascular registry between January 1992 and January 2001. Indications, demographics, morbidity, and mortality were retrieved. These results were compared on the basis of gender as well as to patients undergoing CEA alone. Significance was assessed using Theta(2) analysis.

RESULTS: There were 563 combined eversion CEA/CABG procedures performed over the 9-year study period: 324 in men and 239 in women. Asymptomatic >70% stenosis was seen in 275 (85%) male patients and 215 (90%) female patients (P = not significant [NS]). Stroke was found in four men vs three women (1.2% vs 1.3%, P = NS), whereas death occurred in 13 men and five women (4.0% vs 2.1%, P = NS). Thirty-day stroke/mortality was 4.9% in men vs 3.3% in women (P = NS). During the same period, patients undergoing CEA alone were subject to a stroke-mortality rate of 1.6% in men and 1.2% in women (P = NS).

CONCLUSION: This series demonstrated no difference in outcome among patients undergoing combined eversion CEA/CABG procedures on the basis of gender. Although the results demonstrate a significantly higher mortality and morbidity in patients undergoing combined procedures when compared to carotid surgery alone, the combined procedures can be performed safely in both genders. The large number of asymptomatic patients in both the combined and solo procedures may have positively influenced these results.