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Published on: March 27, 2018
Sex Differences in Long-term Outcomes Following Coronary Artery Bypass Grafting: A Nationwide Population-Based
Suk Kyung Lim1, Yong Ho Jeong2, Yun Jin Kim3,4
1Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Insights
Female patients undergoing coronary artery bypass grafting (CABG) show better long-term survival than males. This nationwide study found no significant difference in cardiac-related mortality between sexes after CABG.
Area of Science:
- Cardiovascular Surgery
- Clinical Outcomes Research
- Sex Differences in Medicine
Background:
- Previous studies on sex differences in coronary artery bypass grafting (CABG) outcomes were limited by data scope.
- Few meta-analyses have examined long-term outcomes after CABG concerning sex differences.
Purpose of the Study:
- To investigate long-term clinical outcomes following coronary artery bypass grafting (CABG) based on sex.
- To address limitations of previous studies by utilizing a nationwide population-based cohort.
Main Methods:
- A nationwide cohort of 48,206 adult patients undergoing first-time isolated CABG (2005-2021) was analyzed.
- Propensity score (PS) matching was employed to control for confounding factors.
- Overall mortality served as the primary outcome measure.
Main Results:
- Female patients (25.5%) were significantly older than male patients.
- In the PS-matched cohort, in-hospital mortality showed no significant sex difference.
- Female sex was associated with significantly better overall survival (HR, 0.83; 95% CI, 0.77-0.90) but not cardiac-related mortality.
Conclusions:
- Female patients undergoing isolated CABG demonstrate superior long-term overall survival compared to male patients.
- No significant difference in cardiac-related mortality was observed between sexes post-CABG.
- Findings highlight important sex-based disparities in long-term outcomes after CABG.
Background:
The relationship between sex differences and clinical outcomes following coronary artery bypass grafting (CABG) has been highlighted in several studies. However, these studies were mostly based on single- or multi-center data, and only a few meta-analyses examined long-term outcomes. To address this limitation, we conducted a nationwide population-based cohort study in Korea.
Methods:
A total of 48,206 adult patients who underwent first-time isolated CABG between January 2005 and December 2021 were enrolled. To address potential confounding, propensity score (PS) matching was conducted. The primary outcome was overall mortality.
Results:
Among the enrolled patients, 12,270 (25.5%) were female. The median age of the overall cohort was 66.0 years (interquartile range [IQR], 59.0-72.0), with female patients (median, 69.0; IQR, 63.0-75.0) being significantly older than male patients (P < 0.001). In the PS-matched cohort, in-hospital mortality did not differ significantly between female and male groups (odds ratio, 1.13; 95% confidence interval [CI], 0.78-1.64). However, the female group was a significant predictor of better overall survival (hazard ratio [HR], 0.83; 95% CI, 0.77-0.90) compared to the male group. Cardiac-related mortality was comparable between the two groups (HR, 0.89; 95% CI, 0.65-1.22). The median duration of the follow-up period was 7.8 (IQR, 4.0-12.6) years.
Conclusion:
In this nationwide population-based PS-matched cohort study, female patients who underwent isolated CABG exhibited significantly lower overall mortality compared to male patients during long-term follow-up, whereas no significant difference was observed in cardiac-related mortality.
