Abstract 18794: Relationships Between Sex and Size and Morbidity and Mortality Among Patients Undergoing Cardiovascular Procedures

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Background. Recent large studies reported improvements in outcomes of cardiovascular procedures over time but have not benefited women. Objective. To explore the role that smaller physical stature may play in explaining differential outcomes of these procedures among men and women. Methods. We used regional data (2003-17) to examine differences in in-hospital complications (bleeding, infection, stroke, low output failure, respiratory failure, RF), mortality and long-term survival among men and women of different body surface area (BSA) categories (<1.6, 1.6-1.7, 1.8-1.9, >=2) undergoing PCI (n=97,205), isolated CABG (27,128), or valve (17,414) while controlling for baseline age, comorbidity, disease severity, and year. Results. Smaller size was associated with worse outcomes among both men and women. In-hospital mortality rates were highest among the smallest men for CABG (5.1% versus 1.8% in largest men (OR=3.1; 95%CI=1.5-6.5; p=0.002)) and PCI (2.4% versus 1.1% (OR=2.5; 95%CI=1.4-4.3; p=0.002)) but not valve where smallest women had the highest mortality (9.3% versus 4.6% in the largest men (OR=2.3; 95%CI=1.7-3.2; p<0.001)). In-hospital complications were highest among smallest men for CABG (18% versus 13% (OR=1.5; 95%CI=0.9-2.3; p=0.100)) and valve (29% versus 26% (OR=1.2; 95%CI=0.7-2.1; p=0.502)) but highest among smallest women for PCI (5.9% versus 2.4% in the largest men (OR=2.7; 95%CI=2.3-3.1; p<0.001)). Long-term survival was worst among smallest men for CABG (HR=2.0; 95% CI=1.5-2.7; p<0.001) and PCI (HR=1.9; 95% CI=1.7-2.2; p<0.0001). Bleeding complications were significantly higher in smaller men (3.4% versus 1.6% (OR=2.2; 95%CI=1.4-3.6; p=0.001)) and women (4.8% versus 1.6% (OR=3.2; 95%CI=2.8-3.8; p<0.001)) undergoing PCI. Conclusions. Peri-operative devices and/or processes of care better tailored to the size of the patient might help to improve outcomes of cardiovascular procedures among women as well as smaller men.

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