Unravelling the Difference Between Men and Women in Post-CABG Survival

作者：Amand F. Schmidt, Saskia Haitjema, Ulrik Sartipy, Martin J. Holzmann, David J. Malenka, Cathy S. Ross, Wiek H. van Gilst, Jean L. Rouleau, Annelijn M. Meeder, Robert A. Baker, Hiroki Shiomi, Takeshi Kimura, Lavinia Tran, Julian A. Smith, Christopher M. Reid, Folkert W. Asselbergs, Hester M. den Ruijter · 发表于：Frontiers in Cardiovascular Medicine · 年份：2022 · DOI：10.3389/fcvm.2022.768972 · 被引用次数：16 · 研究领域：Acute Myocardial Infarction Research、Cardiac Health and Mental Health、Sex and Gender in Healthcare

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 su...