Author:
Schmidt Amand F.,Haitjema Saskia,Sartipy Ulrik,Holzmann Martin J.,Malenka David J.,Ross Cathy S.,van Gilst Wiek,Rouleau Jean L.,Meeder Annelijn M.,Baker Robert A.,Shiomi Hiroki,Kimura Takeshi,Tran Lavinia,Smith Julian A.,Reid Christopher M.,Asselbergs Folkert W.,den Ruijter Hester M.
Abstract
ObjectivesWomen have a worse prognosis after coronary artery bypass grafting (CABG) surgery compared to men. We sought to quantify to what extent this difference in post-CABG survival could be attributed to sex itself, or whether this was mediated by difference between men and women at the time of intervention. Additionally, we explored to what extent these effects were homogenous across patient subgroups.MethodsTime to all-cause mortality was available for 102,263 CABG patients, including 20,988 (21%) women, sourced through an individual participant data meta-analysis of five cohort studies. Difference between men and women in survival duration was assessed using Kaplan–Meier estimates, and Cox’s proportional hazards model.ResultsDuring a median follow-up of 5 years, 13,598 (13%) patients died, with women more likely to die than men: female HR 1.20 (95%CI 1.16; 1.25). We found that differences in patient characteristics at the time of CABG procedure mediated this sex effect, and accounting for these resulted in a neutral female HR 0.98 (95%CI 0.94; 1.02). Next we performed a priori defined subgroup analyses of the five most prominent mediators: age, creatinine, peripheral vascular disease, type 2 diabetes, and heart failure. We found that women without peripheral vascular disease (PVD) or women aged 70+, survived longer than men (interaction p-values 0.04 and 6 × 10–5, respectively), with an effect reversal in younger women.ConclusionSex differences in post-CABG survival were readily explained by difference in patient characteristics and comorbidities. Pre-planned analyses revealed patient subgroups (aged 70+, or without PVD) of women that survived longer than men, and a subgroup of younger women with comparatively poorer survival.
Funder
Hartstichting
ZonMw
British Heart Foundation
University College London Hospitals Biomedical Research Centre
Hjärt-Lungfonden
Subject
Cardiology and Cardiovascular Medicine
Reference20 articles.
1. Sex differences in coronary artery disease: pathological observations.;Yahagi;Atherosclerosis.,2015
2. Sex differences in the prevalence of, and trends in, cardiovascular risk factors, treatment, and control in the United States, 2001 to 2016.;Peters;Circulation.,2019
3. Sex differences in mechanisms, presentation and management of ischaemic heart disease.;Crea;Atherosclerosis.,2015
4. Coronary artery bypass grafting in women 50 years or younger.;Dalén;J Am Heart Assoc.,2019
5. Long–term outcome in men and women after CABG; results from the IMAGINE trial.;den Ruijter;Atherosclerosis.,2014
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