Higher Mortality in Women After Coronary Artery Bypass: Meta-analysis and Bias Analysis of Confounding

Shi, Daniel; Zhang, Betty; Motamed, Mehras; Lee, Sandra; Wang, Patrick; McLaren, Christie; Petsikas, Dimitri; Brogly, Susan B.

doi:10.1016/j.athoracsur.2020.11.039

Cited by 8 publications

(4 citation statements)

References 40 publications

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“…Females were with older age, smaller BMI, and higher incidences of insulin-dependent diabetes, hypertension, chronic kidney disease, and cerebrovascular disease. This was in accordance with literature published before [ 1 , 3 , 20 ].…”

Section: Discussionsupporting

confidence: 93%

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Impact of gender differences on hemostasis in patients after coronary artery bypass grafts surgeries in the context of tranexamic acid administration

Wang

Wang²,

et al. 2022

J Cardiothorac Surg

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Background Sex differences present in the blood management of patients after coronary artery bypass grafts (CABG) surgeries. Tranexamic acid (TXA) performed well in maintaining hemostasis during and after surgeries. However, the impact of sex differences on blood control after CABG in patients who received TXA was not investigated. Methods Overall, 29,536 patients undergoing CABG with TXA administration from 2009 to 2019 in our hospital were included. Propensity score matching was performed. Finally, 6808 males and 6808 females were matched based on 23 covariates. Results Female patients had a 0.36-fold lower incidence of reoperations due to major hemorrhage or cardiac tamponade compared to males (1.3% vs. 2.0%, p = 0.001, OR = 0.64, 95%CI = 0.49–0.84). Females had a median of 100 ml less blood loss in 24 h (median 360 vs. 460 ml, p < 0.0001), 150 ml less in 48 h (median 580 vs. 730 ml, p < 0.0001), and 180 ml less in total (median 760 vs. 940 ml, p < 0.0001) than male patients. The red blood cell (RBC) transfusion rate in female was 1.53-fold higher than that in male (33.0% vs. 21.6%, OR = 1.53, 95% CI = 1.43–1.63, p < 0.0001). Females also had higher morbidities than males after CABGs. Conclusions Females had less blood loss than males after CABG with the TXA treatment. Females still had a higher RBC transfusion rate after surgery. Morbidities in women were also higher than that in men.

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Section: Discussionsupporting

confidence: 93%

“…The results were in accordance with the literature before [ 2 – 5 , 7 , 14 , 18 , 19 , 25 ]. Shi et al [ 3 ] reported a meta-analysis incorporating 5,008,262 patients after CABG. The overall 30-day mortality was 4.9% in women versus 3.3% in men.…”

Section: Discussionmentioning

confidence: 99%

Impact of gender differences on hemostasis in patients after coronary artery bypass grafts surgeries in the context of tranexamic acid administration

Wang

Wang²,

et al. 2022

J Cardiothorac Surg

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“…Some have shown that the higher mortality among women was due to background risk factors and others have not. 5,6 Although the discrepancy in survival between women and men has decreased during the last decades, further improvement and research are needed. 4 A study by Liotta et al showed that even minimal changes in serum creatinine values were associated with an increased mortality.…”

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confidence: 99%

The Association Between Acute Kidney Injury and Mortality After Coronary Artery Bypass Grafting Was Similar in Women and Men

Bell

Sartipy

Holzmann

et al. 2022

Journal of Cardiothoracic and Vascular Anesthesia

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“…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 ). Third, it has been observed that women, having a smaller body surface area, have a smaller caliber of the coronary arteries than men, and therefore the risk of incomplete or imperfect revascularization, i.e., early graft failure, can determine worse short- and long-term outcome.…”

Section: Discussionmentioning

confidence: 99%

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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Higher Mortality in Women After Coronary Artery Bypass: Meta-analysis and Bias Analysis of Confounding

Cited by 8 publications

References 40 publications

Impact of gender differences on hemostasis in patients after coronary artery bypass grafts surgeries in the context of tranexamic acid administration

Impact of gender differences on hemostasis in patients after coronary artery bypass grafts surgeries in the context of tranexamic acid administration

The Association Between Acute Kidney Injury and Mortality After Coronary Artery Bypass Grafting Was Similar in Women and Men

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

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