Advertisement

Comparison by Meta-Analysis of Mortality After Isolated Coronary Artery Bypass Grafting in Women Versus Men

      Short- and long-term mortality in women who undergo coronary artery bypass grafting (CABG) has been evaluated in multiple studies with conflicting results. The investigators conducted a meta-analysis of all existing studies to evaluate the impact of female gender on mortality in patients who undergo isolated CABG. A comprehensive search of studies published through May 31, 2012 identified 20 studies comparing men and women who underwent isolated CABG. All-cause mortality was evaluated at short-term (postoperative period and/or at 30 days), midterm (1-year), and long-term (5-year) follow-up. Odds ratios (ORs) and 95% confidence interval (CIs) were calculated using a random-effects model. A total of 966,492 patients (688,709 men [71%], 277,783 women [29%]) were included in this meta-analysis. Women were more likely to be older; had significantly greater co-morbidities, including hypertension, diabetes mellitus, hyperlipidemia, unstable angina, congestive heart failure, and peripheral vascular disease; and were more likely to undergo urgent CABG (51% vs 44%, p <0.01). Short-term mortality (OR 1.77, 95% CI 1.67 to 1.88) was significantly higher in women. At midterm and long-term follow-up, mortality remained high in women compared with men. Women remained at increased risk for short-term mortality in 2 subgroup analyses including prospective studies (n = 41,500, OR 1.83, 95% CI 1.59 to 2.12) and propensity score–matched studies (n = 11,522, OR 1.36, 95% CI 1.04 to 1.78). In conclusion, women who underwent isolated CABG experienced higher mortality at short-term, midterm, and long-term follow-up compared with men. Mortality remained independently associated with female gender despite propensity score–matched analysis of outcomes.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Alam M, Lee VV, Elayda MA, Shahzad SA, Yang EY, Nambi V, Jneid H, Pan W, Coulter S, Wilson JM, Ramanathan KB, Ballantyne CM, Virani SS. Association of gender with morbidity and mortality after isolated coronary artery bypass grafting. A propensity score matched analysis. Int J Cardiol Epub 2012 Jan 10.

        • Saxena A.
        • Dinh D.
        • Smith J.A.
        • Shardey G.
        • Reid C.M.
        • Newcomb A.E.
        Sex differences in outcomes following isolated coronary artery bypass graft surgery in Australian patients: analysis of the Australasian Society of Cardiac and Thoracic Surgeons cardiac surgery database.
        Eur J Cardiothorac Surg. 2012; 41: 755-762
        • Emmert M.Y.
        • Salzberg S.P.
        • Seifert B.
        • Schurr U.P.
        • Odavic D.
        • Reuthebuch O.
        • Genoni M.
        Despite modern off-pump coronary artery bypass grafting women fare worse than men.
        Interact Cardiovasc Thorac Surg. 2010; 10: 737-741
        • Fukui T.
        • Takanashi S.
        Gender differences in clinical and angiographic outcomes after coronary artery bypass surgery.
        Circ J. 2010; 74: 2103-2108
        • Bukkapatnam R.N.
        • Yeo K.K.
        • Li Z.
        • Amsterdam E.A.
        Operative mortality in women and men undergoing coronary artery bypass grafting (from the California Coronary Artery Bypass Grafting Outcomes Reporting Program).
        Am J Cardiol. 2010; 105: 339-342
        • Ennker I.C.
        • Albert A.
        • Pietrowski D.
        • Bauer K.
        • Ennker J.
        • Florath I.
        Impact of gender on outcome after coronary artery bypass surgery.
        Asian Cardiovasc Thorac Ann. 2009; 17: 253-258
        • Kasirajan V.
        • Wolfe L.G.
        • Medina A.
        Adverse influence of female gender on outcomes after coronary bypass surgery: a propensity matched analysis.
        Interact Cardiovasc Thorac Surg. 2009; 8: 408-411
        • Humphries K.H.
        • Gao M.
        • Pu A.
        • Lichtenstein S.
        • Thompson C.R.
        Significant improvement in short-term mortality in women undergoing coronary artery bypass surgery (1991 to 2004).
        J Am Coll Cardiol. 2007; 49: 1552-1558
        • Guru V.
        • Fremes S.E.
        • Austin P.C.
        • Blackstone E.H.
        • Tu J.V.
        Gender differences in outcomes after hospital discharge from coronary artery bypass grafting.
        Circulation. 2006; 113: 507-516
        • Hassan A.
        • Chiasson M.
        • Buth K.
        • Hirsch G.
        Women have worse long-term outcomes after coronary artery bypass grafting than men.
        Can J Cardiol. 2005; 21: 757-762
        • Woods S.E.
        • Noble G.
        • Smith J.M.
        • Hasselfeld K.
        The influence of gender in patients undergoing coronary artery bypass graft surgery: an eight-year prospective hospitalized cohort study.
        J Am Coll Surg. 2003; 196: 428-434
        • Koch C.G.
        • Khandwala F.
        • Nussmeier N.
        • Blackstone E.H.
        Gender and outcomes after coronary artery bypass grafting: a propensity-matched comparison.
        J Thorac Cardiovasc Surg. 2003; 126: 2032-2043
        • Hogue Jr., C.W.
        • Barzilai B.
        • Pieper K.S.
        • Coombs L.P.
        • DeLong E.R.
        • Kouchoukos N.T.
        • Dávila-Román V.G.
        Sex differences in neurological outcomes and mortality after cardiac surgery: a society of thoracic surgery national database report.
        Circulation. 2001; 103: 2133-2137
        • Abramov D.
        • Tamariz M.G.
        • Sever J.Y.
        • Christakis G.T.
        • Bhatnagar G.
        • Heenan A.L.
        • Goldman B.S.
        • Fremes S.E.
        The influence of gender on the outcome of coronary artery bypass surgery.
        Ann Thorac Surg. 2000; 70: 800-805
        • Aldea G.S.
        • Gaudiani J.M.
        • Shapira O.M.
        • Jacobs A.K.
        • Weinberg J.
        • Cupples A.L.
        • Lazar H.L.
        • Shemin R.J.
        Effect of gender on postoperative outcomes and hospital stays after coronary artery bypass grafting.
        Ann Thorac Surg. 1999; 67: 1097-1103
        • Edwards F.H.
        • Carey J.S.
        • Grover F.L.
        • Bero J.W.
        • Hartz R.S.
        Impact of gender on coronary bypass operative mortality.
        Ann Thorac Surg. 1998; 66: 125-131
        • Hammar N.
        • Sandberg E.
        • Larsen F.F.
        • Ivert T.
        Comparison of early and late mortality in men and women after isolated coronary artery bypass graft surgery in Stockholm, Sweden 1980 to 1989.
        J Am Coll Cardio. 1997; 29: 659-664
        • Christakis G.T.
        • Weisel R.D.
        • Buth K.J.
        • Fremes S.E.
        • Rao V.
        • Panagiotopoulos K.P.
        • Ivanov J.
        • Goldman B.S.
        • David T.E.
        Is body size the cause for poor outcomes of coronary artery bypass operations in women?.
        J Thorac Cardiovasc Surg. 1995; 110: 1344-1356
        • O'Connor G.T.
        • Morton J.R.
        • Diehl M.J.
        • Olmstead E.M.
        • Coffin L.H.
        • Levy D.G.
        • Maloney C.T.
        • Plume S.K.
        • Nugent W.
        • Malenka D.J.
        Differences between men and women in hospital mortality associated with coronary artery bypass graft surgery. The Northern New England Cardiovascular Disease Study Group.
        Circulation. 1993; 88: 2104-2110
        • Fisher L.D.
        • Kennedy J.W.
        • Davis K.B.
        • Maynard C.
        • Fritz J.K.
        • Kaiser G.
        • Myers W.O.
        Association of sex, physical size, and operative mortality after coronary artery bypass in the Coronary Artery Surgery Study (CASS).
        J Thorac Cardiovasc Surg. 1982; 84: 334-341
        • Blasberg J.D.
        • Schwartz G.S.
        • Balaram S.K.
        The role of gender in coronary surgery.
        Eur J Cardiothorac Surg. 2011; 40: 715-721
        • Arias E.
        • Curtin L.R.
        • Wei R.
        • Anderson R.N.
        U.S. decennial life tables for 1999–2001, United States life tables.
        Natl Vital Stat Rep. 2008; 57: 1-36
        • Jacobs A.K.
        Coronary revascularization in women in 2003: sex revisited.
        Circulation. 2003; 107: 375-377
        • Blankstein R.
        • Ward R.P.
        • Arnsdorf M.
        • Jones B.
        • Lou Y.B.
        • Pine M.
        Female gender is an independent predictor of operative mortality after coronary artery bypass graft surgery: contemporary analysis of 31 midwestern hospitals.
        Circulation. 2005; 112: I323-I327
        • Kim C.
        • Redberg R.F.
        • Pavlic T.
        • Eagle K.A.
        A systematic review of gender differences in mortality after coronary artery bypass graft surgery and percutaneous coronary interventions.
        Clin Cardiol. 2007; 30: 491-495
      2. Wells GA, Shea B, O'Connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm. Accessed April 12, 2013.

        • Mickleborough L.L.
        • Takagi Y.
        • Maruyama H.
        • Sun Z.
        • Mohamed S.
        Is sex a factor in determining operative risk for aortocoronary bypass graft surgery?.
        Circulation. 1995; 92: II80-II84
        • Chandra N.C.
        • Ziegelstein R.C.
        • Rogers W.J.
        • Tiefenbrunn A.J.
        • Gore J.M.
        • French W.J.
        • Rubison M.
        Observations of the treatment of women in the United States with myocardial infarction: a report from the National Registry of Myocardial Infarction-I.
        Arch Intern Med. 1998; 158: 981-988
        • Khan S.S.
        • Nessim S.
        • Gray R.
        • Czer L.S.
        • Chaux A.
        • Matloff J.
        Increased mortality of women in coronary artery bypass surgery: evidence for referral bias.
        Ann Intern Med. 1990; 112: 561-567
        • Blomkalns A.L.
        • Chen A.Y.
        • Hochman J.S.
        • Peterson E.D.
        • Trynosky K.
        • Diercks D.B.
        • Brogan Jr., G.X.
        • Boden W.E.
        • Roe M.T.
        • Ohman E.M.
        • Gibler W.B.
        • Newby L.K.
        • CRUSADE Investigators
        Gender disparities in the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes: large-scale observations from the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines) National Quality Improvement Initiative.
        J Am Coll Cardiol. 2005; 45: 832-837