Gender-based time discrepancy in diagnosis of coronary artery disease based on data analytics of electronic medical records

Panahiazar, Maryam; Bishara, Andrew; Chern, Yorick; Alizadehsani, Roohallah; Islam, Sheikh Mohammed Shariful; Hadley, Dexter; Arnaout, Rima; Beygui, Ramin E.

doi:10.3389/fcvm.2022.969325

Cited by 4 publications

(4 citation statements)

References 17 publications

(14 reference statements)

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“…Several reasons have been reported in the literature to fully or at least partially explain a possible worse outcome of female gender after CABG. First, it is reported that there is a difference from the first time of admission to diagnostic cardiac catheterization in female gender in comparison with men, which may account, given the delay observed, for the more severe urgent or emergent clinical presentation at the time of CABG surgery, consequently increasing the operative risk in women ( 8 ). Secondly, the progression of the atherosclerotic disease most likely occurs in women at the end of childbearing age, i.e., when the protective estrogenic effect is less and therefore as compared with men, women arrive at the observation with more advanced age, which “ per se ” represents one of the most important predictors of worse in-hospital outcome ( 9 , 10 ).…”

Section: Discussionmentioning

confidence: 99%

“…Several reasons may have contributed to similar operative results in our study. Panahiazar et al ( 8 ) reported that, as compared with men, women had an extra 127 days delay between angiographic diagnosis and coronary artery bypass graft. Being a referral center for CABG surgery, it is possible that there was no delay in the clinical diagnosis and surgical treatment in women in comparison with men.…”

Section: Discussionmentioning

confidence: 99%

“…The possible negative effect of female gender on medium- and long-term prognosis after CABG is still a matter of open debate. In some studies, it is reported that the worst long-term prognosis of women may depend on female gender “ per se ” ( 6 - 8 ), in other studies on the worst clinical presentation typical for females, even after CABG surgery. Nurkkala et al ( 9 ) in a systematic analysis of 5,950 CABG patients (962 women, 16%) observed that the risk of cardiac death was 2.5-fold greater in women undergoing CABG than in men operated in comparison to non-operated healthy counterparts of the same sex.…”

Section: Discussionmentioning

confidence: 99%

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The role of the female gender on mid-term outcome after coronary artery bypass grafting: a retrospective study

Nardi,

Pisano,

Bassano

et al. 2024

J Thorac Dis

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Background Data on female gender differences on clinical prognosis after coronary artery bypass grafting (CABG) are still controversial. We evaluated retrospectively the impact of women patients in comparison with men undergoing CABG on mid-term outcome. Methods Between December 2014 and March 2022, 1,044 consecutive patients (162 females, 15.5%, 882 males, 84.5%) underwent isolated CABG. The mean follow-up was 40±27 (median 38) months. Logistic and Cox model analysis regressions were used to assess the risk of female gender and other variables, Kaplan-Meier estimates to assess survival rates. Results Women did not have a significant higher operative mortality than men (3.09% vs. 1.93%; P=0.37). There was no difference in the use of left internal mammary artery (97.5% vs . 94.9%; P=0.85). Independent predictors of early mortality were emergency CABG (P<0.0001), percutaneous coronary intervention (PCI) within 30 days (P=0.0026), and higher EuroSCORE II (P=0.0155). At 7.5 years, actuarial survival was 87%±3.6% for female gender vs. 88%±1.9% in male gender (P=0.41), freedom from cardiac death 97%±1.8% vs. 96.6%±1.0% (P=0.6), freedom from major adverse cardiac events (MACE) 87%±6.2% vs. 89.7%±2.5% (P=0.96). Independent predictor of all-causes death and cardiac death was the advanced age (74 years in dead patients vs. 67 years in survivors) (P<0.0001). Female gender was not a predictor of either operative mortality (P=0.34) or worse mid-term outcome (P=0.41). Conclusions Women undergoing CABG with the same surgical techniques currently adopted for men, do not appear to be associated with worse early prognosis. Freedom from late all-causes mortality, cardiac death and adverse cardiac events are comparable and equally satisfactory, highlighting the positive protective effect of CABG over time also in women.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The role of the female gender on mid-term outcome after coronary artery bypass grafting: a retrospective study

Nardi,

Pisano,

Bassano

et al. 2024

J Thorac Dis

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“…Using ML in clinical decision making can provide a more comprehensive analysis of all available data on patients suspected of CAD, which may be difficult for physicians to do objectively [66][67][68][69]. Cardiologists have to integrate several data sources, including clinical data, CT imaging, and SPECT stress testing, among others, to make clinical decisions, but there is no consistent method for integrating all of this information [70][71][72]. Additionally, guidelines recommend including certain variables in the myocardial perfusion imaging (MPI) report, but there is currently no standardized way to include them in the report [73].…”

Section: Plos Onementioning

confidence: 99%

Patient-level explainable machine learning to predict major adverse cardiovascular events from SPECT MPI and CCTA imaging

Alahdab,

El Shawi,

Ahmed

et al. 2023

PLoS ONE

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Background Machine learning (ML) has shown promise in improving the risk prediction in non-invasive cardiovascular imaging, including SPECT MPI and coronary CT angiography. However, most algorithms used remain black boxes to clinicians in how they compute their predictions. Furthermore, objective consideration of the multitude of available clinical data, along with the visual and quantitative assessments from CCTA and SPECT, are critical for optimal patient risk stratification. We aim to provide an explainable ML approach to predict MACE using clinical, CCTA, and SPECT data. Methods Consecutive patients who underwent clinically indicated CCTA and SPECT myocardial imaging for suspected CAD were included and followed up for MACEs. A MACE was defined as a composite outcome that included all-cause mortality, myocardial infarction, or late revascularization. We employed an Automated Machine Learning (AutoML) approach to predict MACE using clinical, CCTA, and SPECT data. Various mainstream models with different sets of hyperparameters have been explored, and critical predictors of risk are obtained using explainable techniques on the global and patient levels. Ten-fold cross-validation was used in training and evaluating the AutoML model. Results A total of 956 patients were included (mean age 61.1 ±14.2 years, 54% men, 89% hypertension, 81% diabetes, 84% dyslipidemia). Obstructive CAD on CCTA and ischemia on SPECT were observed in 14% of patients, and 11% experienced MACE. ML prediction’s sensitivity, specificity, and accuracy in predicting a MACE were 69.61%, 99.77%, and 96.54%, respectively. The top 10 global predictive features included 8 CCTA attributes (segment involvement score, number of vessels with severe plaque ≥70, ≥50% stenosis in the left marginal coronary artery, calcified plaque, ≥50% stenosis in the left circumflex coronary artery, plaque type in the left marginal coronary artery, stenosis degree in the second obtuse marginal of the left circumflex artery, and stenosis category in the marginals of the left circumflex artery) and 2 clinical features (past medical history of MI or left bundle branch block, being an ever smoker). Conclusion ML can accurately predict risk of developing a MACE in patients suspected of CAD undergoing SPECT MPI and CCTA. ML feature-ranking can also show, at a sample- as well as at a patient-level, which features are key in making such a prediction.

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Health Disparities in the Neurosurgical Care of Patients with Trigeminal Neuralgia

Reyes,

Shelley,

Vinjamuri

et al. 2024

World Neurosurgery

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Gender-based time discrepancy in diagnosis of coronary artery disease based on data analytics of electronic medical records

Cited by 4 publications

References 17 publications

The role of the female gender on mid-term outcome after coronary artery bypass grafting: a retrospective study

The role of the female gender on mid-term outcome after coronary artery bypass grafting: a retrospective study

Patient-level explainable machine learning to predict major adverse cardiovascular events from SPECT MPI and CCTA imaging

Health Disparities in the Neurosurgical Care of Patients with Trigeminal Neuralgia

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