Update: Gender differences in CABG outcomes—Have we bridged the gap?

Matyal, Robina; Qureshi, Nada Qaisar; Mufarrih, Syed Hamza; Sharkey, Aidan; Bose, Ruma; Chu, Louis M.; Liu, David C.; Senthilnathan, Venkatachalam; Mahmood, Feroze; Khabbaz, Kamal R.

doi:10.1371/journal.pone.0255170

Cited by 17 publications

(19 citation statements)

References 30 publications

(42 reference statements)

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“…Several observational studies reported higher 30-day mortality rates in women [26][27][28][29][30]. We could not confirm this result based on our data in line with other studies [2,[31][32][33]. The unadjusted and the overlap weighted cohorts presented similar in-hospital mortality rates.…”

Section: Plos Onecontrasting

confidence: 91%

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Long-term survival of female versus male patients after coronary artery bypass grafting

2022

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Background Several of the most extensively used risk prediction tools for coronary artery bypass grafting outcomes include female sex as an independent risk factor for postoperative outcomes. It is not clear whether this putative increased surgical risk impacts long-term survival. This study aimed to assess sex differences in 10-year all-cause mortality. Methods Retrospective analysis of 5340 consecutive patients undergoing primary isolated coronary artery bypass surgery, performed from 2000 to 2015, in a Portuguese level III Hospital. The primary endpoint was all-cause mortality at ten years. We employed an overlap weighting algorithm to minimize confounding. Its target population highlights patients with the most overlap in their observed characteristics, and its corresponding estimand is the average treatment effect in the overlap population. Results We identified that 5340 patients underwent isolated CABG: 1104 (20.7%) were female, and 4236 (79.3%) were male. Sixteen patients were lost to follow-up (0.3%). The median follow-up time was 12.79 (IQR, 9.52–16.66) years: 12.68 (IQR, 9.48–16.54) years for the male patient group and 13.13 (IQR, 9.75–16.98) years for the female patient group. The primary endpoint of all-cause mortality at ten years occurred in 1106 patients (26.1%) in the male patient group, compared with 315 (28.5%) in the female patient group. The unweighted survival analysis for both groups reveals the worst long-term prognosis for the female cohort (hazard ratio, 1.22; 95% CI, 1.10 to 1.35; p < 0.001), while in the overlap weighted survival analysis, such long-term difference in prognosis disappears (hazard ratio, 0.98; 95% CI, 0.88 to 1.09; p = 0.693). Conclusion In this longitudinal, population-level analysis of patients undergoing primary, isolated CABG, we demonstrated that the female sex is not associated with increased long-term all-cause mortality compared to their male counterparts. Thus, sex should not influence the undertaking of an adequate revascularization strategy.

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Section: Plos Onecontrasting

confidence: 91%

“…As documented in other series, women represented about 25% of patients undergoing CABG from 2000 to 2015 [25,33]. Whether this might represent a referral bias is not supported by our data.…”

Section: Plos Onecontrasting

confidence: 39%

Long-term survival of female versus male patients after coronary artery bypass grafting

2022

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“…Female sex has previously been associated with increased cardiovascular mortality and morbidity after CABG (4,5,23).…”

Section: Discussionmentioning

confidence: 97%

“…Outcomes of coronary heart disease (CHD) and coronary artery bypass crafting (CABG) have constantly improved over the past decades ( 1 – 3 ). However, women’s prognosis after coronary events and revascularizations, including CABG, still remain markedly impaired compared to that of men ( 4 , 5 ). The mechanisms explaining this observed sex difference are undoubtedly multifactorial and partially related to older age at the time of surgery and greater comorbidity ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

“…The obvious benefits of CABG are significantly improved quality of life ( 13 ) and decreased mortality ( 4 , 14 , 15 ), but conversely, the procedure exposes the patient to several other late post-operative comorbidities and even unexpected conditions such as depression ( 16 ). Most previous studies have assessed the impact of CABG on cardiovascular disease (CVD) morbidity ( 17 – 19 ), but CABG is also found to associate with several non-CVD traits such as anemia, gastrointestinal traits, septicemia, lung cancer, Alzheimer’s disease and chronic obstructive pulmonary disease ( 20 ), which may be reflective of the shared comorbidities between these diseases and CHD.…”

Section: Introductionmentioning

confidence: 99%

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Sex differences in coronary artery bypass grafting-related morbidity and mortality

Nurkkala

Kauko²,

Palmu³

et al. 2022

Front. Cardiovasc. Med.

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BackgroundCoronary artery bypass grafting (CABG) is associated with both cardiovascular disease (CVD) and non-CVD traits. In addition, women’s prognosis after coronary events and revascularizations is worse than in men. As the course of CVD in women differs from that of men, we performed a phenome-wide analysis on the sex differences in CABG -related morbidity and mortality.Materials and methodsWe performed an untargeted analysis on the sex differences in predictors and outcomes of CABG. We studied a sample of 176,680 FinnGen participants, including 5,950 individuals who underwent CABG (4,988 men and 962 women) and were followed between 1998 and 2019. Over 1,100 different traits were analyzed for both sexes and the results were adjusted with age, smoking status and BMI. Cox proportional hazards models with sex-trait interactions were used to estimate the associations between (1) traits and incident CABG; and (2) CABG and incident traits.ResultsIn women, CABG was more strongly related to greater increases in risk of diseases such as hypertension, Alzheimer’s, aortic aneurysms, gout, and chronic kidney disease compared to risk increases observed in men (all interaction p-values < 0.03). After CABG, men had 2.5-fold (p = 3.1E−15) and women 6.3-fold (p = 9.4E−08) greater risk of cardiac death compared to same-sex individuals who did not undergo CABG (p for interaction 8.2E−4). Moreover, the risk of death in women remained higher even 12 years after CABG, whereas the long-term risk of death in men was not increased, compared to same-sex individuals who did not undergo CABG.ConclusionThe adverse outcomes after CABG, both quantity and quality, also appear to differ between men and women. In women, CABG is related to greater long-term increases in risk of cardiac death and several other disease states than in men. Consideration should therefore be given to whether women receive adequate long-term post-operative therapy and follow-up as CABG is not associated with equally improved cardiovascular disease prognosis in women than in men.

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Operative Outcomes of Women Undergoing Coronary Artery Bypass Surgery in the US, 2011 to 2020

et al. 2023

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ImportanceIt has been reported that women undergoing coronary artery bypass have higher mortality and morbidity compared with men but it is unclear if the difference has decreased over the last decade.ObjectiveTo evaluate trends in outcomes of women undergoing coronary artery bypass in the US from 2011 to 2020.Design, Setting, and ParticipantsThis retrospective cohort study at hospitals contributing to the Adult Cardiac Surgery Database of the Society of Thoracic Surgeons included 1 297 204 patients who underwent primary isolated coronary artery bypass from 2011 to 2020.ExposureCoronary artery bypass.Main Outcomes and MeasuresThe primary outcome was operative mortality. The secondary outcome was the composite of operative mortality and morbidity (including operative mortality, stroke, kidney failure, reoperation, deep sternal wound infection, prolonged mechanical ventilation, and prolonged hospital stay). The attributable risk (the association of female sex with coronary artery bypass grafting outcomes) for the primary and secondary outcomes was calculated.ResultsBetween 2011 and 2020, 1 297 204 patients underwent primary isolated coronary artery bypass grafting with a mean age of 66.0 years, 317 716 of which were women (24.5%). Women had a higher unadjusted operative mortality (2.8%; 95% CI, 2.8-2.9 vs 1.7%; 95% CI, 1.7-1.7; P &lt; .001) and overall unadjusted incidence of the composite of operative mortality and morbidity compared with men (22.9%; 95% CI, 22.7-23.0 vs 16.7%; 95% CI, 16.6-16.8; P &lt; .001). The attributable risk of female sex for operative mortality varied from 1.28 in 2011 to 1.41 in 2020, with no significant change over the study period (P for trend = 0.38). The attributable risk for the composite of operative mortality and morbidity was 1.08 in both 2011 and 2020 with no significant change over the study period (P for trend = 0.71).Conclusions and RelevanceWomen remain at significantly higher risk for adverse outcomes following coronary artery bypass grafting and no significant improvement has been seen over the course of the last decade. Further investigation into the determinants of operative outcomes in women is urgently needed.

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Update: Gender differences in CABG outcomes—Have we bridged the gap?

Cited by 17 publications

References 30 publications

Long-term survival of female versus male patients after coronary artery bypass grafting

Long-term survival of female versus male patients after coronary artery bypass grafting

Sex differences in coronary artery bypass grafting-related morbidity and mortality

Operative Outcomes of Women Undergoing Coronary Artery Bypass Surgery in the US, 2011 to 2020

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