After adjusting for patient characteristics and comorbidities at the time of procedure, female sex was not associated with worse post-CABG survival compared to male sex (HR 0.98).
Meta-Analysis (n=102,263)
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Does female sex independently worsen all-cause mortality in patients undergoing CABG?
The worse post-CABG survival observed in women is primarily driven by differences in baseline characteristics and comorbidities at the time of surgery rather than female sex itself.
Hazard Ratio: 0.98 (95% CI 0.94–1.02)
Tasa de eventos absoluta: 16% vs 13%
Objectives Women 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. Methods Time 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. Results During 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. Conclusion Sex 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.
Schmidt et al. (Wed,) conducted a meta-analysis in Coronary artery disease requiring CABG (n=102,263). Female sex vs. Male sex was evaluated on Time to all-cause mortality (adjusted) (HR 0.98, 95% CI 0.94-1.02). After adjusting for patient characteristics and comorbidities at the time of procedure, female sex was not associated with worse post-CABG survival compared to male sex (HR 0.98).