Key result
In an overlap-weighted analysis, female sex was not associated with an increased risk of 10-year all-cause mortality compared to male sex after isolated coronary artery bypass grafting.
Why the study?
Female sex is considered an independent risk factor in CABG risk prediction tools, but whether this putative increased risk affects long-term survival remains unclear.
Does female sex increase 10-year all-cause mortality in patients undergoing primary isolated CABG compared to male sex?
Observational (n=5,340)
No
Does female sex increase 10-year all-cause mortality in patients undergoing primary isolated CABG compared to male sex?
After adjusting for baseline differences using overlap weighting, female sex is not associated with increased long-term all-cause mortality after isolated CABG, challenging traditional risk scores.
Answers are grounded in this paper and cite their sources.
Supports equivalent long-term survival by sex after CABG; observational data leaves open confirmation in prospective trials.
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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Abreu et al. (2022) conducted an observational in Ischemic heart disease (n=5,340). Female sex vs. Male sex was evaluated on All-cause mortality at ten years (HR 0.98, 95% CI 0.88 to 1.09, p=0.693). In an overlap-weighted analysis, female sex was not associated with an increased risk of 10-year all-cause mortality compared to male sex after isolated coronary artery bypass grafting.
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