37. Females and Patients with Low Socioeconomic Status Are Less Likely to Undergo Multi-Arterial Grafting
University of Ottawa Heart Institute
Ottawa, ON
Canada - Contact Me
Dr. Marc Ruel received his MD cum laude from the University of Ottawa in 1994 and his Royal College certification in cardiac surgery in 2000. He pursued a scholarship in minimally invasive surgery and lab research at Harvard, where he also obtained a Master’s in Public Health. Dr. Ruel is a Professor in the Departments of Surgery and Cellular and Molecular Medicine at the University of Ottawa.
Dr. Ruel co-pioneered multiarterial minimally invasive coronary artery bypass surgery worldwide, as well as other cardiac surgical techniques. His career is dedicated to making heart surgery less invasive, leading to better patient outcomes, and being more evidence-based.
Throughout Dr. Ruel’s extended 11-year tenure as Cardiac Surgery Chair in Ottawa (two 5-year terms being the maximum allowed), the Ottawa program massively grew in volumes, scope, and outreach (including a new partnership with Newfoundland and Labrador), quality, research and innovation, advanced education, as well as in outside referrals, international reputation, global recruitment, and overall impact.
Dr. Ruel is the author of more than 500 scientific publications and chapters, including 6 books, and has delivered over 300 invited lectures, most of them internationally. He leads key international trials in cardiac surgery (including the MIST and ODIN randomized controlled trials), is a recipient of numerous academic and community awards. The laboratory research program founded by Dr. Ruel at the start of his career (www.beatsresearch.com) has also achieved high translational impact.
Dr. Ruel is the immediate Past-President of the Canadian Cardiovascular Society, which he led to receive its first-ever federal funding, embark on new public advocacy initiatives in COVID, myocarditis, and heart failure, and launch the Canadian Alliance of Cardiovascular Centres. Dr. Ruel serves as Surgery Editor for the journal Circulation, Canadian Director for the STS, and North American Director for the ISMICS.
Michigan Medicine
Ann Arbor, MI
United States - Contact Me
Dr. Catherine Wagner is a PGY-5 integrated cardiothoracic surgery resident at the University of Michigan. She is interested in cardiac surgery quality, sex outcomes disparities, and childbearing during training. Dr. Wagner is interested in pursuing a career in academic cardiac surgery.
Abstract
Methods: Patients undergoing isolated CABG with two or more bypass grafts from 2011 to 2022 were evaluated in a statewide collaborative database. Patients with a history of mediastinal radiation, prior cardiac surgery, emergent/salvage status, and subclavian stenosis were excluded. Patients were stratified by the distressed community index (DCI) score, a socioeconomic ranking by zip code (scale of 0-100, 100 being the most distressed). Hierarchical regression modeling was performed to associate DCI and sex with MAG, incorporating patient factors (e.g., age, BMI, diabetes, creatinine) and surgery year, with hospital and surgeon as random effects.
Results: A total of 39,004 patients underwent CABG at 33 centers. The mean age was 66±10 years and 24% (n=9,388) were female. Compared to males, females lived in zip codes associated with higher median DCI (51 [IQR 24, 72] vs 42 [IQR 17, 66]), p<0.001). The overall rate of MAG was 15% and was lower among females (10% versus 17%, p<0.001). Overall adjusted odds of receiving MAG increased throughout the study period (2012 vs 2018, OR 0.20 [95% CI 0.17-0.22], p<0.001). After multivariable adjustment, females were less likely to receive MAG compared to males (OR 0.51 [95% CI 0.45-0.58], p<0.001) (Figure). Similarly, patients living in zip codes with a higher DCI score had lower adjusted odds of receiving MAG (OR 0.90 per 10-point increase [95% CI 0.87-0.94], p<0.001). There was no association between Black race (vs White race) and MAG (OR 0.88 [95% CI 0.76-1.02] p=0.24). The impact of DCI and sex on MAG did not change by surgery-year (p>0.05) suggesting these effects did not change over time.
Conclusions: After risk adjustment, females are half as likely to undergo MAG during CABG than males. Similarly, patients from low socioeconomic status are less likely to receive MAG, even after accounting for risk and hospital. These disparity gaps persisted even though the overall rate of MAG increased over time. Increased attention to identify and address barriers to MAG in these populations is required to provide more equitable surgical revascularization practices.