Schmidt, Amand F;
Haitjema, Saskia;
Sartipy, Ulrik;
Holzmann, Martin J;
Malenka, David J;
Ross, Cathy S;
van Gilst, Wiek;
... den Ruijter, Hester M; + view all
(2022)
Unravelling the Difference Between Men and Women in Post-CABG Survival.
Frontiers in Cardiovascular Medicine
, 9
, Article 768972. 10.3389/fcvm.2022.768972.
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Abstract
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. CONCLUSIONS: 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.
| Type: | Article |
|---|---|
| Title: | Unravelling the Difference Between Men and Women in Post-CABG Survival |
| Location: | Switzerland |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.3389/fcvm.2022.768972 |
| Publisher version: | https://doi.org/10.3389/fcvm.2022.768972 |
| Language: | English |
| Additional information: | © 2022 Schmidt, Haitjema, Sartipy, Holzmann, Malenka, Ross, van Gilst, Rouleau, Meeder, Baker, Shiomi, Kimura, Tran, Smith, Reid, Asselbergs and den Ruijter. This is an open-access article distributed under the terms of the Creative Commons Attribution License (Chttp://creativecommons.org/licenses/by/4.0/). |
| Keywords: | sex, gender, CABG, outcome, prognosis, atherosclerosis |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10148799 |
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