Women under 50 at greater risk after bypass surgery

DALLAS -- Women under age 50 are three times more likely than men to die after undergoing coronary artery bypass surgery, new research suggests.

A study led by Dr. Viola Vaccarino of Emory University in Atlanta examined 57,187 patients, 30 percent of them women, who had bypass surgery at 23 medical centers across the country between October 1993 and December 1999.

Among patients ages 50-59, 2.6 percent of women died, compared with 1.1 percent of men. Among patients 80 and older, 9 percent of women died compared with 8.3 percent of men. The study found that the difference decreases with advancing age.

"It's a puzzling result," Vaccarino said. "We're not able to explain the difference based on our data. It could be a factor we didn't know about or test for."

Overall, 5.3 percent of the women died in the hospital, compared with 2.9 percent of the men. Of the women younger than 50, 3.4 percent died, compared with 1.1 percent of men.

Vaccarino theorized that women tend to have more preexisting illnesses, including stroke and heart failure, and are usually referred for surgery when their heart disease is more severe.

Because women have smaller arteries than men, she said, bypass surgery is more difficult to perform and, therefore, more stressful on women.

"It's probably a combination of those factors," she said of the findings, published in Tuesday's issue of the journal Circulation. "Whatever the case, though, younger women usually have a worse outcome."

Dr. Eric Topol, cardiology chief at the Cleveland Clinic, believes women under 50 who have bypass surgery likely have an aggressive form of the disease, making them more likely to have complications following surgery.

"Research tells us that women should be protected from coronary disease by a decade" compared with men, said Topol, who was not involved in the study. "Genetics likely play a large role in their development of the disease. Young women, my goodness, you wouldn't expect the death rate to be as high as it is."

Vaccarino said women should not interpret the study to mean bypass surgery is dangerous for them. They should instead recognize the need to be examined for heart disease earlier in life, she said.

"Women just need to be aware that they're a high-risk group," Vaccarino said. "The same group of women, without a bypass, could be doing much worse."

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