Abstract
OBJECTIVE: Despite declining mortality after coronary artery bypass grafting, it is unclear if Black or female patients similarly benefit. We hypothesized differences in outcomes persist and disproportionately affect Black women. METHODS: We examined patients undergoing isolated coronary artery bypass grafting from July 2011 to July 2023 in a multicenter regional collaborative. Patients were stratified by race and sex: White men, White women, Black men, and Black women. Hierarchical logistic regression analyses were performed to identify trends and risk factors associated with operative mortality. RESULTS: Among 27,309 patients, White men, White women, Black men, and Black women made up 66.1%, 19.2%, 9.3%, and 5.4% of the cohort, respectively. Their Society of Thoracic Surgeons Predicted Risk of Mortality was 0.83%, 1.55%, 1.11%, and 1.66%, respectively (P < .001). Mortality (1.5% vs 2.7% vs 2.5% vs 3.2%, P < .001) and major morbidity (8% vs 12% vs 14% vs 17%, P < .001) were highest in Black women. There was no reduction in mortality over time (odds ratio [OR], 1.06 95% CI, 0.95-1.2, P = .338). Compared with White men, White women (OR, 1.53, 95% CI, 1.22-1.91, P < .001), Black men (OR, 1.41, 95% CI, 1.04-1.9, P = .026), and Black women (OR, 1.8, 95% CI, 1.28-2.53, P = .001) had higher risk-adjusted odds of mortality. Society of Thoracic Surgeons Predicted Risk of Mortality (OR, 1.13, 95% CI, 1.11-1.14, P < .001), distress score (OR, 1.01 95% CI, 1.01-1.01, P = .007), log anastomosis ratio (OR, 0.775, 95% CI, 0.625-0.962, P = .021), and bypass time (OR, 1.01, 95% CI, 1.01-1.01, P < .001) were associated with mortality. CONCLUSIONS: Differences persist with Black women having the highest risk-adjusted odds of mortality after coronary artery bypass grafting. Reinvigorated efforts are needed in an era of plateauing mortality rates.