Female Sex is Associated with Short-term Mortality in Coronary Artery Bypass Grafting Patients: A Propensity-matched Analysis

Overview

Journal Heliyon

Date 2025 Feb 3

PMID 39897798

Authors

Mostafa Abbas

Thomas Morland

Rohit Sharma

Jeffrey Shuhaiber

H Lester Kirchner

Yasser El-Manzalawy

Affiliations

Soon will be listed here.

Abstract

Background: Females undergoing coronary artery bypass grafting (CABG) surgery have been reported to be at increased risk of postoperative mortality and comorbidity. Our main objective is to evaluate the impact of female sex on 30-day mortality after isolated CABG surgery.

Methods: We created a retrospective cohort of adult patients underwent isolated CABG surgery between 2006 and 2020 in a large rural healthcare system. Patients were grouped by sex and a 1:1 nearest neighbor propensity score matching method was performed to reduce the bias due to potential confounding. Association between female sex and 30-day mortality was assessed using conditional regression analysis and appropriate statistical tests for matched analyses. Associations between female sex and eight secondary outcomes were also considered.

Results: Out of 5616 adult patients underwent isolated CABG surgery, 1352 were females. The propensity scoring matching method provided 1346 matched pairs with no observed significant imbalance for any of the included confounders. The conditional logistic regression analysis showed independent association between female sex and 30-day mortality (OR = 1.83, CI = 1.10-3.04, p = 0.02).

Conclusions: Females undergoing isolated CABG surgery were at significantly greater risk of postoperative 30-day mortality and longer postoperative length of stay. Further research is needed to identify and address the causes of these disparities.

References

Puskas J, Kilgo P, Thourani V, Lattouf O, Chen E, Vega J . The society of thoracic surgeons 30-day predicted risk of mortality score also predicts long-term survival. Ann Thorac Surg. 2011; 93(1):26-33. DOI: 10.1016/j.athoracsur.2011.07.086. View

Enumah Z, Canner J, Alejo D, Warren D, Zhou X, Yenokyan G . Persistent Racial and Sex Disparities in Outcomes After Coronary Artery Bypass Surgery: A Retrospective Clinical Registry Review in the Drug-eluting Stent Era. Ann Surg. 2020; 272(4):660-667. PMC: 8491278. DOI: 10.1097/SLA.0000000000004335. View

Koch C, Khandwala F, Nussmeier N, Blackstone E . Gender and outcomes after coronary artery bypass grafting: a propensity-matched comparison. J Thorac Cardiovasc Surg. 2003; 126(6):2032-43. DOI: 10.1016/s0022-5223(03)00950-4. View

Al-Alao B, Parissis H, McGovern E, Tolan M, Young V . Gender influence in isolated coronary artery bypass graft surgery: a propensity match score analysis of early outcomes. Gen Thorac Cardiovasc Surg. 2012; 60(7):417-24. DOI: 10.1007/s11748-012-0082-7. View

Swaminathan R, Feldman D, Pashun R, Patil R, Shah T, Geleris J . Gender Differences in In-Hospital Outcomes After Coronary Artery Bypass Grafting. Am J Cardiol. 2016; 118(3):362-8. DOI: 10.1016/j.amjcard.2016.05.004. View

Roques F, Michel P, Goldstone A, Nashef S . The logistic EuroSCORE. Eur Heart J. 2003; 24(9):881-2. DOI: 10.1016/s0195-668x(02)00799-6. View

Kotting J, Beckmann A, Dobler K, Schafer E, Veit C, Welz A . German CABG score: a specific risk model for patients undergoing isolated coronary artery bypass grafting. Thorac Cardiovasc Surg. 2014; 62(4):276-87. DOI: 10.1055/s-0033-1364193. View

Saxena A, Dinh D, Smith J, Shardey G, Reid C, Newcomb A . 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(4):755-62. DOI: 10.1093/ejcts/ezr039. View

Dixon L, Dimagli A, Di Tommaso E, Sinha S, Fudulu D, Sandhu M . Females have an increased risk of short-term mortality after cardiac surgery compared to males: Insights from a national database. J Card Surg. 2022; 37(11):3507-3519. PMC: 9826035. DOI: 10.1111/jocs.16928. View

10.

Nuru A, Weltzien J, Sandvik L, Tonnessen T, Bjornstad J . Short- and long-term survival after isolated coronary artery bypass grafting, the impact of gender and age. Scand Cardiovasc J. 2019; 53(6):342-347. DOI: 10.1080/14017431.2019.1646430. View

11.

Nashef S, Roques F, Sharples L, Nilsson J, Smith C, Goldstone A . EuroSCORE II. Eur J Cardiothorac Surg. 2012; 41(4):734-44. DOI: 10.1093/ejcts/ezs043. View

12.

Filardo G, Hamman B, Pollock B, da Graca B, Sass D, Phan T . Excess short-term mortality in women after isolated coronary artery bypass graft surgery. Open Heart. 2016; 3(1):e000386. PMC: 4809184. DOI: 10.1136/openhrt-2015-000386. View

13.

Kimenai D, Shah A, Mills N . A sex-specific prediction model is not enough to achieve equality for women in preventative cardiovascular medicine. Eur Heart J. 2021; 43(3):239-240. PMC: 8790764. DOI: 10.1093/eurheartj/ehab759. View

14.

Navar-Boggan A, Peterson E, DAgostino Sr R, Pencina M, Sniderman A . Using age- and sex-specific risk thresholds to guide statin therapy: one size may not fit all. J Am Coll Cardiol. 2015; 65(16):1633-1639. PMC: 7036292. DOI: 10.1016/j.jacc.2015.02.025. View

15.

Chung R, Xu Z, Arnold M, Stevens D, Keogh R, Barrett J . Prioritising cardiovascular disease risk assessment to high risk individuals based on primary care records. PLoS One. 2023; 18(9):e0292240. PMC: 10540947. DOI: 10.1371/journal.pone.0292240. View

16.

Shahian D, Jacobs J, Badhwar V, Kurlansky P, Furnary A, Cleveland Jr J . The Society of Thoracic Surgeons 2018 Adult Cardiac Surgery Risk Models: Part 1-Background, Design Considerations, and Model Development. Ann Thorac Surg. 2018; 105(5):1411-1418. DOI: 10.1016/j.athoracsur.2018.03.002. View

17.

Gaudino M, Samadashvili Z, Hameed I, Chikwe J, Girardi L, Hannan E . Differences in Long-term Outcomes After Coronary Artery Bypass Grafting Using Single vs Multiple Arterial Grafts and the Association With Sex. JAMA Cardiol. 2020; 6(4):401-409. PMC: 7758835. DOI: 10.1001/jamacardio.2020.6585. View

18.

Mohamed W, Mohamed M, Hirji S, Ouzounian M, Sun L, Coutinho T . Trends in sex-based differences in outcomes following coronary artery bypass grafting in the United States between 2004 and 2015. Int J Cardiol. 2020; 320:42-48. DOI: 10.1016/j.ijcard.2020.07.039. View

19.

Robinson N, Naik A, Rahouma M, Morsi M, Wright D, Hameed I . Sex differences in outcomes following coronary artery bypass grafting: a meta-analysis. Interact Cardiovasc Thorac Surg. 2021; 33(6):841-847. PMC: 8632758. DOI: 10.1093/icvts/ivab191. View

20.

Chung J, Stevens L, Ouzounian M, El-Hamamsy I, Bouhout I, Dagenais F . Sex-Related Differences in Patients Undergoing Thoracic Aortic Surgery. Circulation. 2019; 139(9):1177-1184. DOI: 10.1161/CIRCULATIONAHA.118.035805. View