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Sex Differences in Outcomes After CABG
Quick Takes
- Women have higher adjusted incidence of adverse cardiac and cerebrovascular events, but similar mortality compared to men after CABG.
- The higher incidence of MACCE is mostly driven by a higher rate of MI and repeat revascularization. Of note, the difference in outcomes between the sexes is not evident after 75 years of age and is significantly affected by preoperative LVEF, but not by variations in the surgical technique used.
- Additional studies focused on improving the outcome of women (especially younger women) undergoing CABG are indicated.
Study Questions:
What are the sex differences in outcomes after coronary artery bypass grafting (CABG)?
Methods:
The investigators 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. 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. The effect of sex on the primary endpoint was calculated using a two-stage approach pooling β coefficients and relative standard error obtained from individual study multivariable Cox regression models.
Results:
Four trials involving 13,193 patients (10,479 males; 2,714 females) were included. Over 5 years of follow-up, women had a significantly higher risk of MACCE (adjusted hazard ratio [aHR], 1.12; 95% confidence interval [CI], 1.04-1.21; p = 0.004) but similar mortality (aHR, 1.03; 95% CI, 0.94-1.14; p = 0.51) compared to men. Women had higher incidence of MI (aHR, 1.30; 95% CI, 1.11-1.52) and repeat revascularization (aHR, 1.22; 95% CI, 1.04-1.43) but not stroke (aHR, 1.17; 95% CI, 0.90-1.52). The difference in MACCE between sexes was not significant in patients aged 75 years and older. The use of off-pump surgery and multiple arterial grafting did not modify the difference between sexes.
Conclusions:
The authors concluded that women have worse outcomes than men in the first 5 years after CABG.
Perspective:
This study reports that after CABG, women have higher adjusted incidence of adverse cardiac and cerebrovascular events, but similar mortality compared to men. The higher incidence of MACCE is mostly driven by a higher rate of MI and repeat revascularization. Of note, the difference in outcomes between the sexes is not evident after 75 years of age and is significantly affected by preoperative left ventricular ejection fraction (LVEF), but not by variations in the surgical technique used. Women have a higher risk of perioperative MI possibly related to technical factors and may be one of the reasons for the difference in mid-term outcomes. Additional studies focused on improving the outcome of women (especially younger women) undergoing CABG are indicated.
Clinical Topics: Cardiac Surgery, Geriatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Prevention, Cardiac Surgery and Arrhythmias
Keywords: Cardiac Surgical Procedures, Coronary Artery Bypass, Geriatrics, Myocardial Infarction, Myocardial Ischemia, Myocardial Revascularization, Primary Prevention, Sex Characteristics, Stroke, Stroke Volume, Ventricular Function, Left, Women
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