Sex difference in the risk factor distributions and outcomes after coronary artery bypass graft surgery in the young population

Abstract

OBJECTIVES Coronary artery disease is becoming a major health concern in the young population. Male and female patients may experience different journeys after coronary artery disease events. We aimed to evaluate risk factors and compare outcomes between young male and female patients undergoing coronary artery bypass graft surgery (CABG). METHODS In this registry-based large sample size study, patients undergoing isolated CABG at a young age (premature isolated CABG) between 2007 and 2016 were included and followed up until 2020. Premature was defined as women and men younger than 55 years old. The main end points of the study were 7-year all-cause mortality and 7-year major adverse cardiovascular and cerebrovascular events (MACCEs). RESULTS Of a total of 24 428 patients who underwent CABG, 7217 patients (men-to-women ratio ≈4:1) with premature isolated CABG were included. The median follow-up duration was 78.5 months (75.2–81.6 months). The prevalence rates of diabetes mellitus, hypertension, dyslipidaemia and obesity were significantly higher in women than in men (58.3% vs 28.6%, 64.2% vs 38.5%, 69.7% vs 55.3% and 44.7 vs 23.9, respectively; all Ps < 0.05). The risk factor burden (mean of the risk factor count per year) was also higher among the female population. Diabetes mellitus was the common mortality predictor between men and women. In the subgroup analysis (interaction analysis in the adjusted model), hypertensive females had a higher rate of MACCE and a higher rate of mortality than hypertensive males; however, this difference was not significant in the non-hypertensive population. Opium addiction was a strong predictor of MACCE and all-cause mortality among men. Female patients had a higher rate of 7-year MACCE (hazard ratio, 1.33; 95% confidence interval, 1.16–1.51) and a higher rate of 7-year all-cause mortality (hazard ratio, 1.23; 95% confidence interval, 0.98–1.53). CONCLUSIONS The risk factor profile and predictors of outcomes were different between our female and male patients. Women carried a higher risk of events and mortality after CABG at a young age.

Early Outcomes of a High PaO2/FiO2 Ratio during Cardiopulmonary Bypass

“… 39 Moreover, women carry a higher risk of events and mortality after CPB at a young age. 40 As a limitation of our study, the patients in Group I were older than those in Group II. Still, the large number of women in Group I may clear up the confusion.…”

Comparison of in-hospital outcomes after coronary artery bypass graft surgery in elders and younger patients: a multicenter retrospective study

“…The results are similar to those of some previous studies [ 7 – 9 ]. It has been suggested that females have a higher risk of adverse cardiovascular events and death after CABG [ 10 , 11 ]. However, gender was not a confounding factor during the data analysis of this study.…”

Mortality across the spectrum of hemoglobin level in patients undergoing surgical coronary revascularization

“…Coronary artery bypass grafting (CABG) surgery is a lifesaving procedure in severe coronary artery disease 2 . Besides the importance of procedure techniques, baseline and preoperative features and comorbidities determine its success rate, in addition to short‐term and long‐term outcomes 3–9 …”

“…2 Besides the importance of procedure techniques, baseline and preoperative features and comorbidities determine its success rate, in addition to short-term and long-term outcomes. [3][4][5][6][7][8][9] Anemia can cause postoperative complications such as arrhythmia, hypoxemia, and heart failure; if left untreated. 10 The major adverse cardiac and cerebrovascular events rate in patients undergoing coronary artery bypass grafting with preoperative anemia is higher than in patients with normal Hb concentration.…”