Sex differences in outcomes after coronary artery bypass grafting: a pooled analysis of individual patient data

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  • Mario Gaudino
    Department of Cardiothoracic Surgery, Weill Cornell Medicine , 525 East 68th Street , New York, NY 10065, USA
  • Antonino Di Franco
    Department of Cardiothoracic Surgery, Weill Cornell Medicine , 525 East 68th Street , New York, NY 10065, USA
  • John H Alexander
    Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center , 40 Duke Medicine Cir, Durham, NC 27710, USA
  • Faisal Bakaeen
    Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic , Carnegie Ave, Cleveland, OH 44103, USA
  • Natalia Egorova
    Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai , 1 Gustave L. Levy Pl, New York, NY 10029, USA
  • Paul Kurlansky
    Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Medical Center , 622 W 168th St, New York, NY 10032, USA
  • Andreas Boening
    Department of Cardiovascular Surgery, Justus-Liebig University Gießen , , Ludwigstraße 23, Gießen 35390, Germany
  • Joanna Chikwe
    Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center , 8700 Beverly Blvd #2900A, Los Angeles, CA 90048, USA
  • Michelle Demetres
    Samuel J. Wood Library and C.V. Starr Biomedical Information Center, Weill Cornell Medicine , 525 East 68th Street , New York, NY 10065, USA
  • Philip J Devereaux
    Population Health Research Institute, McMaster University , 1280 Main St W, Hamilton, ON L8S 4L8, Canada
  • Anno Diegeler
    Department Cardiac Surgery, Cardiovascular Center Bad Neustadt/Saale, Von-Guttenberg-Straße 11, Bad Neustadt/Saale 97616, Germany
  • Arnaldo Dimagli
    Bristol Heart Institute, University of Bristol , Terrell St, Bristol BS2 8ED, UK
  • Marcus Flather
    Research and Development Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust , Colney Ln, Norwich NR4 7UY, UK
  • Irbaz Hameed
    Department of Cardiothoracic Surgery, Weill Cornell Medicine , 525 East 68th Street , New York, NY 10065, USA
  • Andre Lamy
    Population Health Research Institute, McMaster University , 1280 Main St W, Hamilton, ON L8S 4L8, Canada
  • Jennifer S Lawton
    Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine , 733 N Broadway, Baltimore, MD 21205, USA
  • Wilko Reents
    Department Cardiac Surgery, Cardiovascular Center Bad Neustadt/Saale, Von-Guttenberg-Straße 11, Bad Neustadt/Saale 97616, Germany
  • N Bryce Robinson
    Department of Cardiothoracic Surgery, Weill Cornell Medicine , 525 East 68th Street , New York, NY 10065, USA
  • Katia Audisio
    Department of Cardiothoracic Surgery, Weill Cornell Medicine , 525 East 68th Street , New York, NY 10065, USA
  • Mohamed Rahouma
    Department of Cardiothoracic Surgery, Weill Cornell Medicine , 525 East 68th Street , New York, NY 10065, USA
  • Patrick W Serruys
    Department of Cardiology, National University of Ireland, University Rd , Galway, Ireland
  • Hironori Hara
    Department of Cardiology, National University of Ireland, University Rd , Galway, Ireland
  • David P Taggart
    Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford , Oxford OX1 2JD, UK
  • Leonard N Girardi
    Department of Cardiothoracic Surgery, Weill Cornell Medicine , 525 East 68th Street , New York, NY 10065, USA
  • Stephen E Fremes
    Schulich Heart Centre Sunnybrook Health Sciences Centre, University of Toronto , Hospital Road, Toronto, ON M4N 3M5, Canada
  • Umberto Benedetto
    Bristol Heart Institute, University of Bristol , Terrell St, Bristol BS2 8ED, UK

説明

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Aims</jats:title> <jats:p>Data suggest that women have worse outcomes than men after coronary artery bypass grafting (CABG), but results have been inconsistent across studies. Due to the large differences in baseline characteristics between sexes, suboptimal risk adjustment due to low-quality data may be the reason for the observed differences. To overcome this limitation, we undertook a systematic review and pooled analysis of high-quality individual patient data from large CABG trials to compare the adjusted outcomes of women and men.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and results</jats:title> <jats:p>The primary outcome was a composite of all-cause mortality, myocardial infarction (MI), stroke, and repeat revascularization (major adverse cardiac and cerebrovascular events, MACCE). The secondary outcome was all-cause mortality. Multivariable mixed-effect Cox regression was used. Four trials involving 13 193 patients (10 479 males; 2714 females) were included. Over 5 years of follow-up, women had a significantly higher risk of MACCE [adjusted hazard ratio (HR) 1.12, 95% confidence interval (CI) 1.04–1.21; P = 0.004] but similar mortality (adjusted HR 1.03, 95% CI 0.94–1.14; P = 0.51) compared to men. Women had higher incidence of MI (adjusted HR 1.30, 95% CI 1.11–1.52) and repeat revascularization (adjusted HR 1.22, 95% CI 1.04–1.43) but not stroke (adjusted HR 1.17, 95% CI 0.90–1.52). The difference in MACCE between sexes was not significant in patients 75 years and older. The use of off-pump surgery and multiple arterial grafting did not modify the difference between sexes.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Women have worse outcomes than men in the first 5 years after CABG. This difference is not significant in patients aged over 75 years and is not affected by the surgical technique.</jats:p> </jats:sec>

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