Mario Gaudino1, Antonino Di Franco1, John H Alexander2, Faisal Bakaeen3, Natalia Egorova4, Paul Kurlansky5, Andreas Boening6, Joanna Chikwe7, Michelle Demetres8, Philip J Devereaux9, Anno Diegeler10, Arnaldo Dimagli11, Marcus Flather12, Irbaz Hameed1, Andre Lamy9, Jennifer S Lawton13, Wilko Reents10, N Bryce Robinson1, Katia Audisio1, Mohamed Rahouma1, Patrick W Serruys14, Hironori Hara14, David P Taggart15, Leonard N Girardi1, Stephen E Fremes16, Umberto Benedetto11. 1. Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA. 2. Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, 40 Duke Medicine Cir, Durham, NC 27710, USA. 3. Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Carnegie Ave, Cleveland, OH 44103, USA. 4. Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, USA. 5. Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Medical Center, 622 W 168th St, New York, NY 10032, USA. 6. Department of Cardiovascular Surgery, Justus-Liebig University Gießen, , Ludwigstraße 23, Gießen 35390, Germany. 7. Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd #2900A, Los Angeles, CA 90048, USA. 8. Samuel J. Wood Library and C.V. Starr Biomedical Information Center, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA. 9. Population Health Research Institute, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada. 10. Department Cardiac Surgery, Cardiovascular Center Bad Neustadt/Saale, Von-Guttenberg-Straße 11, Bad Neustadt/Saale 97616, Germany. 11. Bristol Heart Institute, University of Bristol, Terrell St, Bristol BS2 8ED, UK. 12. Research and Development Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Ln, Norwich NR4 7UY, UK. 13. Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA. 14. Department of Cardiology, National University of Ireland, University Rd, Galway, Ireland. 15. Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford OX1 2JD, UK. 16. Schulich Heart Centre Sunnybrook Health Sciences Centre, University of Toronto, Hospital Road, Toronto, ON M4N 3M5, Canada.
Abstract
AIMS: 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. METHODS AND RESULTS: 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. CONCLUSIONS: 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. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: 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. METHODS AND RESULTS: 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. CONCLUSIONS: 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. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: S E Sheifer; M R Canos; K P Weinfurt; U K Arora; F O Mendelsohn; B J Gersh; N J Weissman Journal: Am Heart J Date: 2000-04 Impact factor: 4.749
Authors: Mahboob Alam; Vei-Vei Lee; McArthur A Elayda; Saima A Shahzad; Eric Y Yang; Vijay Nambi; Hani Jneid; Wei Pan; Stephanie Coulter; James M Wilson; Kodangudi B Ramanathan; Christie M Ballantyne; Salim S Virani Journal: Int J Cardiol Date: 2012-01-10 Impact factor: 4.164
Authors: Eric J Velazquez; Kerry L Lee; Robert H Jones; Hussein R Al-Khalidi; James A Hill; Julio A Panza; Robert E Michler; Robert O Bonow; Torsten Doenst; Mark C Petrie; Jae K Oh; Lilin She; Vanessa L Moore; Patrice Desvigne-Nickens; George Sopko; Jean L Rouleau Journal: N Engl J Med Date: 2016-04-03 Impact factor: 91.245
Authors: Mario Gaudino; John H Alexander; Natalia Egorova; Paul Kurlansky; Andre Lamy; Faisal Bakaeen; Irbaz Hameed; Antonino Di Franco; Michelle Demetres; N Bryce Robinson; Joanna Chikwe; Jennifer S Lawton; P J Devereaux; David P Taggart; Marcus Flather; Wilko Reents; Andreas Boening; Anno Diegeler; Leonard N Girardi; Stephen E Fremes; Umberto Benedetto Journal: J Card Surg Date: 2020-07-27 Impact factor: 1.620
Authors: Victor Lamin; Amenah Jaghoori; Rachel Jakobczak; Irene Stafford; Tamila Heresztyn; Michael Worthington; James Edwards; Fabiano Viana; Robert Stuklis; David P Wilson; John F Beltrame Journal: J Am Heart Assoc Date: 2018-07-09 Impact factor: 5.501
Authors: Xiaomeng Xu; Shu Huang; YuE Zeng; Yulan Feng; Dongqi Yue; Fanxia Shen; Yang Gao; Bei Zhang; Yang Yang; Lin Gu; Yi Fu Journal: Front Aging Neurosci Date: 2022-03-08 Impact factor: 5.750