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Ferreira DK, Petzold AP, Zawislak RB, Oliveira JRD, Wagner MB, Piantá RM, Kalil RAK, Guaragna JCVDC, Bodanese LC. Sex differences in outcomes of patients undergoing on-pump coronary artery bypass grafting surgery. PLoS One 2024; 19:e0306902. [PMID: 39240799 DOI: 10.1371/journal.pone.0306902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 06/25/2024] [Indexed: 09/08/2024] Open
Abstract
There are controversies regarding the impact of sex on mortality and postoperative complications in patients undergoing on-pump coronary artery bypass grafting (CABG), although some studies demonstrate comparable outcomes. This study sought to evaluate sex differences regarding risk factors associated with hospital mortality and postoperative clinical outcomes among patients undergoing isolated on-pump CABG. We conducted a retrospective observational cohort study of patients who underwent isolated on-pump CABG from January 1996 to January 2020. Patients were divided into two groups (male and female) and compared regarding preoperative characteristics, surgical technical variables, and in-hospital outcomes. All-cause mortality between groups was compared using logistic regression. Risk factors for mortality, along with their respective odds ratios (OR), were separately assessed using a logistic regression model with p-values for interaction. We analyzed 4,882 patients, of whom 31.6% were female. Women exhibited a higher prevalence of age >75 years (12.2% vs 8.3%, p<0.001), obesity (22.6% vs 11.5%, p<0.001), diabetes (41.6% vs 32.2%, p<0.001), hypertension (85.2% vs 73.5%, p<0.001), and NYHA functional classes 3 and 4 (16.2% vs 11.2%, p<0.001) compared to men. Use of the mammary artery for revascularization was less frequent among women (73.8% vs 79.9%, p<0.001), who also received fewer saphenous vein grafts (2.17 vs 2.27, p = 0.002). A history of previous or recent myocardial infarction (MI) had an impact on women's mortality, unlike in men (OR 1.61 vs 0.94, p = 0.014; OR 1.86 vs 0.99, p = 0.015, respectively). After adjusting for several risk factors, mortality was found to be comparable between men and women, with an OR of 1.20 (95% CI 0.94-1.53, p = 0.129). In conclusion, female patients undergoing isolated on-pump CABG presented with a higher number of comorbidities. Previous and recent MI were associated with higher mortality only in women. In this cohort analysis, female gender was not identified as an independent risk factor for outcome after CABG.
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Affiliation(s)
- Débora Klein Ferreira
- Postgraduate Program in Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Aline Petracco Petzold
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rafael Braccio Zawislak
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Jarbas Rodrigues de Oliveira
- Postgraduate Program in Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Mario Bernardes Wagner
- Postgraduate Program in Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Ricardo Medeiros Piantá
- Department of Cardiovascular Surgery, Hospital São Lucas-Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Renato Abdala Karam Kalil
- Department of Surgery, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Joao Carlos Vieira da Costa Guaragna
- Postgraduate Program in Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Department of Cardiology, Hospital Divina Providência, Porto Alegre, Rio Grande do Sul, Brazil
| | - Luiz Carlos Bodanese
- Postgraduate Program in Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Mazzucco S, Li L, Tuna MA, Rothwell PM. Age-specific sex-differences in cerebral blood flow velocity in relation to haemoglobin levels. Eur Stroke J 2024; 9:772-780. [PMID: 38634499 PMCID: PMC11343687 DOI: 10.1177/23969873241245631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/20/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Cerebral blood flow (CBF) declines with age and abnormalities in CBF are associated with age-related cerebrovascular disease and neurodegeneration. Women have higher CBF than men, although this sex-difference diminishes to some extent with age in healthy subjects. The physiological drivers of these age/sex differences are uncertain, but might be secondary to age and sex-differences in haemoglobin (Hb) level. Hb levels are inversely correlated with CBF, are lower in women, and decline with age in men, but the interrelations between these factors have not been explored systematically either in healthy subjects or across the full age-range in patients with vascular risk factors. We aimed to determine the age-specific interrelations between sex, Hb, and CBF velocity in a large cohort of patients with cerebrovascular disease. PATIENTS AND METHODS In patients with a recent transient ischaemic attack or minor stroke (Oxford Vascular Study) and no ipsilateral or contralateral stenosis of the carotid or intracranial arteries, we related peak-systolic velocity (PSV) and other parameters on transcranial Doppler ultrasound (TCD) of the middle cerebral artery to sex, age, Hb and vascular risk factors. RESULTS Of 958 eligible subjects (mean age/SD = 68.04/14.26, 53.2% male), younger women (age < 55 years) had higher CBF velocities than men (mean sex difference in PSV at age < 55 years = 16.31 cm/s; p < 0.001), but this difference declined with age (interaction p < 0.001), such that it was no longer significant at age 75-84 (∆PSV = 3.26 cm/s; p = 0.12) and was reversed at age ⩾ 85 (∆PSV = -7.42 cm/s; p = 0.05). These changes mirrored trends in levels of Hb, which were higher in men at age < 55 (∆Hb = 1.92 g/dL; p < 0.001), but steadily decreased with age in men but not in women (interaction p < 0.001), with no residual sex-difference at age ⩾ 85 (∆Hb = 0.12 g/dL; p = 0.70). There was an inverse correlation between Hb and PSV in both women and men (both p ⩽ 0.01), and the sex-difference in PSV at age < 55 was substantially diminished after adjustment for Hb (∆PSV = 6.92; p = 0.036; ∆PSV = 5.92, p = 0.13 with further adjustment for end-tidal CO2). In contrast, the sex difference in PSV was unaffected by adjustment for systolic and diastolic blood pressure, heart rate, and vascular risk factors (history of hypertension, diabetes, hyperlipidaemia and smoking). DISCUSSION CBF velocity is strongly correlated with Hb level at all ages, and sex-differences in CBF velocity appear to be explained in major part by age-related sex-differences in Hb.
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Affiliation(s)
- Sara Mazzucco
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Linxin Li
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Maria Assuncao Tuna
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Peter M Rothwell
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Karamnov S, Sarkisian N, Wollborn J, Justice S, Fields K, Kovacheva VP, Osho AA, Sabe A, Body SC, Muehlschlegel JD. Sex, Atrial Fibrillation, and Long-Term Mortality After Cardiac Surgery. JAMA Netw Open 2024; 7:e2426865. [PMID: 39167408 PMCID: PMC11339658 DOI: 10.1001/jamanetworkopen.2024.26865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 06/10/2024] [Indexed: 08/23/2024] Open
Abstract
Importance There are limited data on the association of sex with the incidence of postoperative atrial fibrillation (poAF) and subsequent long-term mortality after cardiac surgery. Objective To evaluate whether the incidence of poAF and associated long-term mortality after cardiac surgery differ by sex. Design, Setting, and Participants This retrospective cohort study was conducted at 2 tertiary care centers in Massachusetts from January 1, 2002, until October 1, 2016, with follow-up until December 1, 2022. Adult (aged >20 years) women and men undergoing coronary artery bypass graft surgery, aortic valve surgery, mitral valve surgery, and combined procedures with cardiopulmonary bypass were examined using medical records. Patients who had data on poAF were included in data analyses. Exposures Sex and poAF. Main Outcomes and Measures Primary outcomes were the incidence of poAF and all-cause mortality. poAF was defined as any atrial fibrillation detected on electrocardiogram (EKG) during the index hospitalization in patients presenting for surgery in normal sinus rhythm. Data on poAF were obtained from EKG reports and supplemented by information from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. All-cause mortality was assessed via hospital records. The hypotheses were formulated prior to data analysis. Results Among 21 568 patients with poAF data (mean [SD] age, 66.5 [12.4] years), 2694 of 6601 women (40.8%) and 5805 of 14 967 men (38.8%) developed poAF. In a multivariable logistic regression model, women had lower risk of poAF (odds ratio [OR], 0.85; 95% CI, 0.79-0.91; P < .001). During the follow-up study period, 1294 women (50.4%) and 2376 men (48.9%) in the poAF group as well as 1273 women (49.6%) and 2484 men (51.1%) in the non-poAF group died. Cox proportional hazards analysis found that the association between poAF and mortality was significantly moderated (ie, effect modified) by sex. Compared with same-sex individuals without poAF, men with poAF had a 17% higher mortality hazard (hazard ratio [HR], 1.17; 95% CI, 1.11-1.25; P < .001), and women with poAF had a 31% higher mortality hazard (HR, 1.31; 95% CI, 1.21-1.42; P < .001). Conclusions and Relevance In this retrospective cohort study of 21 568 patients who underwent cardiac surgery, women were less likely to develop poAF than men when controlling for other relevant characteristics; however, women who did develop poAF had a higher risk of long-term mortality than men who developed poAF. This observed elevated risk calls for a tailored approach to perioperative care in women undergoing cardiac surgery.
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Affiliation(s)
- Sergey Karamnov
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Natalia Sarkisian
- Department of Sociology, Boston College, Chestnut Hill, Massachusetts
| | - Jakob Wollborn
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Samuel Justice
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kara Fields
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Vesela P. Kovacheva
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Asishana A. Osho
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Ashraf Sabe
- Division of Cardiac Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Simon C. Body
- Department of Anesthesiology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Jochen D. Muehlschlegel
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Doenst T, Faerber G. Challenge-skill balance in cardiac surgery: an attempt to explain sex-related differences in coronary surgery. Eur Heart J 2024; 45:2545-2547. [PMID: 38860698 DOI: 10.1093/eurheartj/ehae350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2024] Open
Affiliation(s)
- Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Am Klinikum 1, D-07747 Jena, Germany
| | - Gloria Faerber
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
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5
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Ren J, Bowyer A, Tian DH, Royse C, El-Ansary D, Royse A. Multiple arterial vs. single arterial coronary artery bypass grafting: sex-related differences in outcomes. Eur Heart J 2024; 45:2536-2544. [PMID: 38820177 DOI: 10.1093/eurheartj/ehae294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/24/2024] [Accepted: 04/30/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND AND AIMS Uncertainty exists over whether multiple arterial grafting has a sex-related association with survival after coronary artery bypass grafting. This study aims to compare the long-term survival of using multiple arterial grafting vs. single arterial grafting in women and men undergoing coronary artery bypass grafting. METHODS The retrospective study used the Australian and New Zealand Society of Cardiothoracic Surgical Database with linkage to the National Death Index. Patients from 2001 to 2020 were identified. Sex-stratified, inverse probability weighted Cox proportional hazard model was used to facilitate survival comparisons. The primary outcome was all-cause mortality. RESULTS A total number of 54 275 adult patients receiving at least two grafts in primary isolated bypass operations were analysed. The entire study cohort consisted of 10 693 (19.7%) female patients and 29 711 (54.7%) multiple arterial grafting procedures. At a median (interquartile range) postoperative follow-up of 4.9 (2.3-8.4) years, mortality was significantly lower in male patients undergoing multiarterial than single arterial procedures (adjusted hazard ratio 0.82; 95% confidence interval 0.77-0.87; P < .001). The survival benefit was also significant for females (adjusted hazard ratio 0.83; 95% confidence interval 0.76-0.91; P < .001) at a median (interquartile range) follow-up of 5.2 (2.4-8.7) years. The interaction model from Cox regression suggested insignificant subgroup effect from sex (P = .08) on the observed survival advantage. The survival benefits associated with multiple arterial grafting were consistent across all sex-stratified subgroups except for female patients with left main coronary disease. CONCLUSIONS Compared to single arterial grafting, multiple arterial revascularization is associated with improved long-term survival for women as well as men.
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Affiliation(s)
- Justin Ren
- Department of Surgery, University of Melbourne, 300 Grattan St, Parkville, Melbourne 3052, Australia
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, 300 Grattan St, Parkville, Melbourne 3052, Australia
| | - Andrea Bowyer
- Department of Surgery, University of Melbourne, 300 Grattan St, Parkville, Melbourne 3052, Australia
- Department of Anesthesia, Royal Melbourne Hospital, Melbourne, Australia
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA
| | - David H Tian
- Department of Surgery, University of Melbourne, 300 Grattan St, Parkville, Melbourne 3052, Australia
- Department of Anaesthesia and Perioperative Medicine, Westmead Hospital, Sydney, Australia
| | - Colin Royse
- Department of Surgery, University of Melbourne, 300 Grattan St, Parkville, Melbourne 3052, Australia
- Department of Anesthesia, Royal Melbourne Hospital, Melbourne, Australia
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA
| | - Doa El-Ansary
- Department of Surgery, University of Melbourne, 300 Grattan St, Parkville, Melbourne 3052, Australia
- School of Biomedical and Health Sciences, Royal Melbourne Institute of Technology, Melbourne, Australia
| | - Alistair Royse
- Department of Surgery, University of Melbourne, 300 Grattan St, Parkville, Melbourne 3052, Australia
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, 300 Grattan St, Parkville, Melbourne 3052, Australia
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Hirnle G, Stankiewicz A, Mitrosz M, Aboul-Hassan SS, Deja M, Rogowski J, Cichoń R, Anisimowicz L, Bugajski P, Tobota Z, Maruszewski B, Hrapkowicz T. Gender Differences in Survival after Coronary Artery Bypass Grafting-13-Year Results from KROK Registry. J Clin Med 2024; 13:4080. [PMID: 39064120 PMCID: PMC11277894 DOI: 10.3390/jcm13144080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/30/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
The influence of gender on both early and long-term outcomes of coronary artery bypass grafting (CABG) is not clearly defined. Objectives: This study aimed to assess the impact of gender on early and long-term mortality after CABG using data from the KROK Registry. Methods: All 133,973 adult patients who underwent CABG in Poland between 1 January 2009 and 31 December 2019 were included in the Polish National Registry of Cardiac Surgical Procedures (KROK Registry). The study enrolled 90,541 patients: 68,401 men (75.55%) and 22,140 women (24.45%) who met the inclusion criteria. Then, 30-day mortality, 1-year mortality, and long-term mortality rates were compared. Results: Advanced age, higher Canadian Cardiovascular Society (CCS) and New York Heart Association (NYHA) grade, diabetes, hypercholesterolemia, arterial hypertension, body mass index BMI > 35 kg/m2, and renal failure, before the propensity matching, were more frequently observed in women. Women more frequently underwent urgent surgery, including single and double graft surgery, and off-pump CABG (OPCAB) (p < 0.001). In propensity-matched groups, early mortality (30 days) was significantly higher in women (3.4% versus 2.8%, p < 0.001). The annual mortality remained higher in this group (6.6% versus 6.0%, p = 0.025). However, long-term mortality differed significantly between the groups and was higher in the male group (33.0% men versus 28.8% women, p < 0.001). Conclusions: There are no apparent differences in long-term mortality between the two sexes in the entire population. In propensity-matched patients, early mortality was lower for men, but the long-term survival was found to be better in women.
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Affiliation(s)
- Grzegorz Hirnle
- Department of Cardiac Surgery, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.S.); (M.M.)
| | - Adrian Stankiewicz
- Department of Cardiac Surgery, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.S.); (M.M.)
| | - Maciej Mitrosz
- Department of Cardiac Surgery, Medical University of Bialystok, 15-276 Bialystok, Poland; (A.S.); (M.M.)
| | - Sleiman Sebastian Aboul-Hassan
- Department of Cardiac Surgery and Interventional Cardiology, Faculty of Medicine and Medical Sciences, University of Zielona Gora, 65-417 Zielona Gora, Poland;
| | - Marek Deja
- Department of Cardiac Surgery, Upper-Silesian Medical Centre, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Jan Rogowski
- Department of Cardiac and Vascular Surgery, Medical University of Gdansk, 80-211 Gdansk, Poland;
| | - Romuald Cichoń
- Lower Silesian Center for Heart Diseases ‘Medinet’, Faculty of Medicine and Medical Sciences, University of Zielona Gora, 65-417 Zielona Gora, Poland;
| | - Lech Anisimowicz
- Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital, 85-094 Bydgoszcz, Poland;
| | - Paweł Bugajski
- Department of Cardiac Surgery, J. Struś Hospital, 61-285 Poznan, Poland;
| | - Zdzisław Tobota
- Department of Paediatric Cardiothoracic Surgery, Children’s Memorial Health Institute, 01-210 Warszawa, Poland; (Z.T.); (B.M.)
| | - Bohdan Maruszewski
- Department of Paediatric Cardiothoracic Surgery, Children’s Memorial Health Institute, 01-210 Warszawa, Poland; (Z.T.); (B.M.)
| | - Tomasz Hrapkowicz
- Department of Cardiac Surgery, Vascular Surgery and Transplantology, Silesian Centre for Heart Diseases, Medical University of Silesia, 41-800 Zabrze, Poland;
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Wagner CM, Ibrahim AM. Sex Disparities After Coronary Artery Bypass Grafting and Hospital Quality. JAMA Netw Open 2024; 7:e2414354. [PMID: 38861261 PMCID: PMC11167499 DOI: 10.1001/jamanetworkopen.2024.14354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/14/2024] [Indexed: 06/12/2024] Open
Abstract
Importance Concern has been raised about persistent sex disparities after coronary artery bypass grafting, with female patients having higher mortality. However, whether these disparities persist across hospitals of different qualities is unknown. Objective To evaluate sex disparities in 30-day mortality after coronary artery bypass grafting across high- and low-quality hospitals. Design, Setting, and Participants This cross-sectional, retrospective cohort study evaluated Medicare beneficiaries undergoing coronary artery bypass grafting between October 1, 2015, and March 31, 2020. Data analysis was performed from July 1, 2023, to December 1, 2023. Exposures The primary exposures were hospital quality and sex. For hospital quality, hospitals were placed into rank order by their overall risk-adjusted mortality rate and divided into quintiles. Main Outcome and Measures Risk-adjusted 30-day mortality using a logistic regression model accounting for patient factors, including sex, age, comorbidities, elective vs unplanned admission, number of bypass grafts, use of arterial graft, and year of surgery. Results A total of 444 855 beneficiaries (mean [SD] age, 71.5 [7.5] years; 120 333 [27.1%] female and 324 522 [72.9%] male) were studied. Compared with male beneficiaries, female beneficiaries were more likely to have an unplanned admission (66 425 [55.2%] vs 157 895 [48.7%], P < .001) and receive care at low-quality (vs high-quality) hospitals (odds ratio, 1.26; 95% CI, 1.23-1.29; P < .001). Overall, risk-adjusted female mortality was 4.24% (95% CI, 4.20%-4.27%), and male mortality was 2.75% (95% CI, 2.75%-2.77%), with an absolute difference of 1.48 (95% CI, 1.45-1.51) percentage points (P < .001). At the highest-quality hospitals, male mortality was 1.57% (95% CI, 1.56%-1.59%), and female mortality was 2.58% (95% CI, 2.54%-2.62%), with an absolute difference of 1.01 (95% CI, 0.97-1.04) percentage points (P < .001). At the lowest-quality hospitals, male mortality was 4.94% (95% CI, 4.88%-5.01%), and female mortality was 7.02% (95% CI, 6.90%-7.13%), with an absolute difference of 2.07 (95% CI, 1.95-2.19) percentage points (P < .001). Female beneficiaries receiving care at low-quality hospitals had a higher mortality than male beneficiaries receiving care at the high-quality hospitals (7.02% vs 1.57%, P < .001). Conclusions and Relevance In this cohort study of Medicare beneficiaries undergoing coronary artery bypass grafting, female beneficiaries were more likely to receive care at low-quality hospitals, where the sex disparity in mortality was double that of high-quality hospitals. Quality improvement targeting low-quality hospitals as well as equitable referral of female beneficiaries to higher-quality hospitals may narrow the sex disparity after coronary artery bypass grafting.
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Affiliation(s)
- Catherine M. Wagner
- National Clinician Scholar’s Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Department of Surgery, Michigan Medicine, Ann Arbor
| | - Andrew M. Ibrahim
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Department of Surgery, Michigan Medicine, Ann Arbor
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Zilio F, Musella F, Ceriello L, Ciliberti G, Pavan D, Manes MT, Selimi A, Scicchitano P, Iannopollo G, Albani S, Fortuni F, Grimaldi M, Colivicchi F, Oliva F. Sex differences in patients presenting with acute coronary syndrome: a state-of-the-art review. Curr Probl Cardiol 2024; 49:102486. [PMID: 38428554 DOI: 10.1016/j.cpcardiol.2024.102486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
Abstract
Cardiovascular conditions in the spectrum of acute coronary syndromes are characterized by sex differences with regard to pathophysiology, risk factors, clinical presentation, invasive and pharmacologic treatment, and outcomes. This review delves into these differences, including specific subsets like myocardial infarction with non-obstructed coronary arteries or Spontaneous Coronary Artery Dissection, and alternative diagnoses like Takotsubo cardiomyopathy or myocarditis. Moreover, practical considerations are enclosed, on how a sex-specific approach should be integrated in clinical practice: in fact, personal history should focus on female-specific risk factors, and hormonal status and hormonal therapy should be assessed. Moreover, physical and psychological stressors should be investigated, particularly in the event of Spontaneous Coronary Artery Dissection or Takotsubo cardiomyopathy.
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Affiliation(s)
- Filippo Zilio
- Department of Cardiology, Santa Chiara Hospital, APSS, 2, Largo Medaglie d'Oro, Trento 38123, Italy.
| | - Francesca Musella
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Cardiology Department, Santa Maria delle Grazie Hospital, Naples, Italy
| | - Laura Ceriello
- Cardiology Department, Ospedale Civile G. Mazzini, Teramo, Italy
| | - Giuseppe Ciliberti
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy
| | - Daniela Pavan
- Cardiology Unit, Azienda Sanitaria "Friuli Occidentale", Pordenone, Italy
| | | | - Adelina Selimi
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy
| | | | - Gianmarco Iannopollo
- Department of Cardiology, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
| | - Stefano Albani
- Division of Cardiology, U. Parini Hospital, Aosta, Italy; Cardiovascular Institute Paris Sud, Massy, France
| | - Federico Fortuni
- Department of Cardiology, San Giovanni Battista Hospital, Foligno, Italy; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Massimo Grimaldi
- Department of Cardiology, General Regional Hospital "F. Miulli", Bari, Italy
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Unit, San Filippo Neri Hospital, Rome, Italy
| | - Fabrizio Oliva
- Cardiologia 1, A. De Gasperis Cardicocenter, ASST Niguarda, Milan, Italy
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9
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Chang FC, Chen CY, Chan YH, Cheng YT, Lin CP, Wu VCC, Hung KC, Chu PH, Chou AH, Chen SW. Sex Differences in Epidemiological Distribution and Outcomes of Surgical Mitral Valve Disease. Circ J 2024; 88:579-588. [PMID: 38267036 DOI: 10.1253/circj.cj-23-0687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
BACKGROUND Mitral valve (MV) disease is the most common form of valvular heart disease. Findings that indicate women have a higher risk for unfavorable outcomes than men remain controversial. This study aimed to determine the sex-based differences in epidemiological distributions and outcomes of surgery for MV disease. METHODS AND RESULTS Overall, 18,572 patients (45.3% women) who underwent MV surgery between 2001 and 2018 were included. Outcomes included in-hospital death and all-cause mortality during follow up. Subgroup analysis was conducted across different etiologies, including infective endocarditis (IE), degenerative, ischemic, and rheumatic mitral pathology. The overall MV repair rate was lower in women than in men (20.5% vs. 30.6%). After matching, 6,362 pairs (woman : man=1 : 1) of patients were analyzed. Women had a slightly higher risk for in-hospital death than men (10.8% vs. 9.8%; odds ratio [OR]: 1.11, 95% confidence interval [CI]: 0.99-1.24; P=0.075). Women tended to have a higher incidence of de novo dialysis (9.8% vs. 8.6%; P=0.022) and longer intensive care unit stay (8 days vs. 7.1 days; P<0.001). Women with IE had poorer in-hospital outcomes than men; however, there were no sex differences in terms of all-cause mortality. CONCLUSIONS Sex-based differences of MV intervention still persist. Although long-term outcomes were comparable between sexes, women, especially those with IE, had worse perioperative outcomes than men.
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Affiliation(s)
- Feng-Cheng Chang
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center
| | - Chun-Yu Chen
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center
| | - Yi-Hsin Chan
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center
| | - Yu-Ting Cheng
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center
| | - Chia-Pin Lin
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center
| | | | - Kuo-Chun Hung
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center
| | - An-Hsun Chou
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center
| | - Shao-Wei Chen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center
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10
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Wester ML, Olsthoorn JR, A Soliman-Hamad M, Houterman S, Roefs MM, Maas AHEM, ter Woorst JFJ. Sex-differences in outcome after off-pump coronary artery bypass grafting is age-dependent; data from the Netherlands Heart Registration. Heliyon 2024; 10:e23899. [PMID: 38205323 PMCID: PMC10776995 DOI: 10.1016/j.heliyon.2023.e23899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
Background Women are known to have worse outcome after coronary artery bypass grafting (CABG) than men. Studies have shown that off-pump coronary artery bypass grafting (OPCAB) might benefit higher-risk patients, and therefore might also benefit women. We aimed to determine differences in early and late outcomes between sexes after OPCAB. Methods Data from all patients undergoing OPCAB, between 2013 through 2021 was retrieved from the Netherlands Heart Registration (NHR) database. Primary outcomes were early mortality, morbidity and late survival. We divided the population into subgroups based on age (aged ≥70 years or < 70 years) and sex. Results This study included 8,487 men and 2,170 women (total = 10,657). Female patients received fewer anastomoses (mean (SD)) women 2.38 (1.17) vs men 2.68 (1.23), p < 0.001) and total arterial revascularization was performed less frequently in women than in men (21.3 % versus 29.5 % respectively, p < 0.001).In the subgroup of patients <70 years, early mortality was 1.7 % in women and 0.6 % in men (p < 0.001). Survival rate at 5 years was 88.4 % in women and 91.1 % in men (p < 0.001). Female sex was associated with worse late survival in the subgroup <70 years (HR (95 % CI) 1.42 (1.10-1.83) p = 0.008). Conclusions Sex-differences in outcome after CABG persists in OPCAB surgery. However, these differences are solely present in the younger subgroup. In our data, women undergoing OPCAB surgery seem to be treated differently during surgery as compared to their male counter parts, further research is needed to analyze this finding.
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Affiliation(s)
- Mara-Louise Wester
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, the Netherlands
| | - Jules R. Olsthoorn
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, the Netherlands
| | | | - Saskia Houterman
- Department of Education and Research, Catharina Hospital Eindhoven, the Netherlands
- Netherlands Heart Registration, Utrecht, the Netherlands
| | | | - Angela HEM. Maas
- Department of Women's Cardiac Health, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joost FJ. ter Woorst
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, the Netherlands
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11
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Alhijab FA, Ismail H, Albabtain M, Alfonso J, Algarni KD, Pragliola C, Adam AI, Arafat AA. The Effect of Gender on Triple Heart Valve Surgery Outcomes; Reinforcing Women's Health. Angiology 2024:33197241226863. [PMID: 38185884 DOI: 10.1177/00033197241226863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Female gender is a risk factor in several cardiac surgery risk stratification systems. This study explored the differences in the outcomes following triple heart valve surgery in men vs women. The study included 250 patients (males n = 101; females n = 149) who underwent triple valve surgery from 2009 to 2020. BMI (body mass index) was higher in females (29.6 vs 26.5 kg/m2, P < .001), and diabetes was more common in males (44 vs 42%, P = .012). The ejection fraction was higher in females (55 vs 50%, P < .001). The severity of mitral valve stenosis and tricuspid valve regurgitation was significantly greater in females (33.11 vs 27.72%, P = .003 and 44.30 vs 19.8%, P < .001, respectively). Mitral valve replacement was more common in females (P < .001), and they had lower concomitant coronary artery bypass grafting (P = .001). Bleeding and renal failure were lower in females (P = .021 and <0.001, respectively). Hospital mortality, readmission, and reintervention were not significantly different between genders. By multivariable analysis, male gender was a risk factor for lower survival [HR (hazard ratio): 2.18; P = .024]. Triple valve surgery can be performed safely in both genders, with better long-term survival in females. Female gender was not a risk factor in patients undergoing triple valve surgery.
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Affiliation(s)
- Fatimah A Alhijab
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Huda Ismail
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Monirah Albabtain
- Cardiac Research Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Juan Alfonso
- Cardiac Research Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Khaled D Algarni
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Claudio Pragliola
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Adam I Adam
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Amr A Arafat
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
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12
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Spiliopoulos K, Magouliotis D, Angelis I, Skoularigis J, Kemkes BM, Salemis NS, Athanasiou T, Gansera B, Xanthopoulos AV. Concomitant Valve Replacement and Coronary Artery Bypass Grafting Surgery: Lessons from the Past, Guidance for the Future? A Mortality Analysis in 294 Patients. J Clin Med 2023; 13:238. [PMID: 38202244 PMCID: PMC10780271 DOI: 10.3390/jcm13010238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/24/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE The aims of this study were to analyze parameters influencing early and late mortality after concomitant valve replacement and coronary artery bypass grafting surgery, using early and long-term information from an institutionally available data registry, and to discuss the results in relation to the current treatment strategies and perspectives. METHODS The study population consisted of 294 patients after combined valve replacement with mechanical prosthesis and CABG surgery. RESULTS There were 201 men (68.4%) and 93 women (31.6%). Concurrent to the coronary artery bypass grafting, 238 patients (80.9%) underwent aortic-, 46 patients (15.6%) mitral- and 10 patients (3.4%) doublevalve replacement. Cumulative duration of follow up was 1007 patient-years (py) with a maximum of 94 months and was completed in 92.2% (271 cases). Overall hospital mortality (30 days) rate was 6.5% (n = 19). It was significantly higher in patients of female gender, older than 70 y, in those suffering preoperative myocardial infarction, presenting with an additive EuroScore > 8 and being hemodynamically unstable after the operation. Cumulative survival rate at 7.6 y was 78.6%. Determinants of prolonged survival were male gender, age at operation < 70 y, preoperative sinus rhythm, normal renal function, additive EuroScore < 8 and the use of internal thoracic artery for grafting. Subsequent multivariate analysis revealed preoperative atrial fibrillation (HR: 2.1, 95% CI: 0.82-5.44, p: 0.01) and risk group of ES > 8 (HR: 3.63, 95% CI: 1.45-9.07, p < 0.01) as independent predictors for lower long-term survival. CONCLUSIONS Hospital mortality (30 d) was nearly 2.5-fold higher in female and/or older than 70 y patients. Preoperative atrial fibrillation and/ or a calculated ES > 8 were independent predisposing factors of late mortality for combined VR and CABG surgery. Tailoring the approach, with the employment of the newest techniques and hybrid procedures, to the individual patient clinical profile enables favorable outcomes for concomitant valvular disease and CAD, especially in high-risk patients.
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Affiliation(s)
- Kyriakos Spiliopoulos
- Department of Cardiothoracic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece; (D.M.); (T.A.)
- Department of Cardiovascular Surgery, Klinikum Bogenhausen, 81925 Munich, Germany (B.G.)
| | - Dimitrios Magouliotis
- Department of Cardiothoracic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece; (D.M.); (T.A.)
| | - Ilias Angelis
- Department of Cardiovascular Surgery, Klinikum Bogenhausen, 81925 Munich, Germany (B.G.)
| | - John Skoularigis
- Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece; (J.S.); (A.V.X.)
| | - Bernhard M. Kemkes
- Department of Cardiovascular Surgery, Klinikum Bogenhausen, 81925 Munich, Germany (B.G.)
| | | | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece; (D.M.); (T.A.)
| | - Brigitte Gansera
- Department of Cardiovascular Surgery, Klinikum Bogenhausen, 81925 Munich, Germany (B.G.)
| | - Andrew V. Xanthopoulos
- Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece; (J.S.); (A.V.X.)
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13
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Benck KN, Alnajar A, Lamelas J. Impact of Bariatric Surgery on Mortality of Mitral Valve Surgery: A National Analysis. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:540-546. [PMID: 37990444 DOI: 10.1177/15569845231207394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
OBJECTIVE Obesity is a common comorbidity of cardiac surgery patients. The goal of this study is to determine if a lower weight achieved through bariatric surgery has any association with mitral valve (MV) replacement or repair surgery mortality. METHODS This study used a retrospective analysis of the National Inpatient Sample dataset from 2012 to 2020. Adult patients who underwent MV surgery with normal weight following bariatric surgery (n = 1,125) and patients with obesity (n = 48,555) were compared. The primary outcome was in-hospital mortality. RESULTS This study included 49,680 patients. The median age was 64 (55 to 71) years, and the majority were female (55%). Bariatric surgery was found to significantly decrease the odds of mortality, even after adjusting for important covariates, indicating a reduction of mortality risk by 54% (adjusted odds ratio = 0.46, p = 0.024). Other significant protective factors include isolated and elective surgery. Significant risk factors were older age, female sex, and diabetes mellitus. Patients who were obese demonstrated longer lengths of stay (LOS), greater transfers to other facilities, and higher hospital costs. CONCLUSIONS In patients receiving MV surgery, bariatric surgery demonstrated significant survival benefits during hospitalization, in addition to reducing LOS and cost. Our data support prior evidence of bariatric surgery improving cardiovascular outcomes. Therefore, bariatric surgery may be a meaningful method of weight loss to improve surgical patient outcomes in patients with obesity. However, longer-term data are needed.
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Affiliation(s)
- Kelley N Benck
- Division of Cardiothoracic Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, FL, USA
| | - Ahmed Alnajar
- Division of Cardiothoracic Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, FL, USA
| | - Joseph Lamelas
- Division of Cardiothoracic Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, FL, USA
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14
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Alnajar A, Benck KN, Dar T, Hirji SA, Ibrahim W, Detweiler B, Vuddanda V, Balise R, Rao JS, Lu M, Lamelas J. Predictors of outcomes in patients with obesity following mitral valve surgery. JTCVS OPEN 2023; 15:127-150. [PMID: 37808032 PMCID: PMC10556846 DOI: 10.1016/j.xjon.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 03/04/2023] [Accepted: 03/13/2023] [Indexed: 10/10/2023]
Abstract
Objective Few studies have assessed the outcomes of mitral valve surgery in patients with obesity. We sought to study factors that determine the in-hospital outcomes of this population to help clinicians provide optimal care. Methods A retrospective analysis of adult patients with obesity who underwent open mitral valve replacement or repair between January 1, 2012, and December 31, 2020, was conducted using the National Inpatient Sample. Weighted logistic regression and random forest analyses were performed to assess factors associated with mortality and the interaction of each variable. Results Of the 48,775 patients with obesity, 34% had morbid obesity (body mass index ≥40), 55% were women, 66% underwent elective surgery, and 55% received isolated open mitral valve replacement or repair. In-hospital mortality was 5.0% (n = 2430). After adjusting for important covariates, a greater risk of mortality was associated with older patients (adjusted odds ratio [aOR], 1.24; 95% CI, 1.08-1.43), higher Elixhauser comorbidity score (aOR, 2.10; 95% CI, 1.87-2.36), prior valve surgery (aOR, 1.63; 95% CI, 1.01-2.63), and more than 2 concomitant procedures (aOR, 2.83; 95% CI, 2.07-3.85). Lower mortality was associated with elective admissions (aOR, 0.70; 95% CI, 0.56-0.87) and valve repair (aOR, 0.58; 95% CI, 0.46-0.73). Machine learning identified several interactions associated with early mortality, such as Elixhauser score, female sex, body mass index ≥40, and kidney failure. Conclusions The complexity of presentation, comorbidities in older and female patients, and morbid obesity are independently associated with an increased risk of mortality in patients undergoing open mitral valve replacement or repair. Morbid obesity and sex disparity should be recognized in this population, and physicians should consider older patients and females with multiple comorbidities for earlier and more opportune treatment windows.
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Affiliation(s)
- Ahmed Alnajar
- Division of Cardiothoracic Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla
- Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Fla
| | - Kelley N. Benck
- Division of Cardiothoracic Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla
| | - Tawseef Dar
- Division of Cardiothoracic Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla
| | - Sameer A. Hirji
- Division of Cardiothoracic Surgery, Brigham and Women's Hospital, Allston, Mass
| | - Walid Ibrahim
- Division of Cardiothoracic Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla
| | - Brian Detweiler
- Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Fla
| | - Venkat Vuddanda
- Division of Cardiothoracic Surgery, Brigham and Women's Hospital, Allston, Mass
| | - Raymond Balise
- Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Fla
| | - J. Sunil Rao
- Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Fla
| | - Min Lu
- Division of Biostatistics, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Fla
| | - Joseph Lamelas
- Division of Cardiothoracic Surgery, DeWitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, Fla
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15
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Rubulotta F, Hemmerling T. Does biological sex matter in solid organ transplantation? Eur J Intern Med 2023; 112:115-116. [PMID: 37029051 DOI: 10.1016/j.ejim.2023.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/09/2023]
Affiliation(s)
- Francesca Rubulotta
- Chair of the Department of Critical Care Medicine, Montreal Canada Chair of iWIN (International Women in Intensive and Critical Care Medicine Network), McGill University, Canada.
| | - Thomas Hemmerling
- Department of Anesthesiology and Division of Experimental Surgery, McGill University, 1400 Rue des Pins, Montreal H3G 1B1, Canada
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Regitz-Zagrosek V, Gebhard C. Gender medicine: effects of sex and gender on cardiovascular disease manifestation and outcomes. Nat Rev Cardiol 2023; 20:236-247. [PMID: 36316574 PMCID: PMC9628527 DOI: 10.1038/s41569-022-00797-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/06/2022]
Abstract
Despite a growing body of evidence, the distinct contributions of biological sex and the sociocultural dimension of gender to the manifestations and outcomes of ischaemic heart disease and heart failure remain unknown. The intertwining of sex-based differences in genetic and hormonal mechanisms with the complex dimension of gender and its different components and determinants that result in different disease phenotypes in women and men needs to be elucidated. The relative contribution of purely biological factors, such as genes and hormones, to cardiovascular phenotypes and outcomes is not yet fully understood. Increasing awareness of the effects of gender has led to efforts to measure gender in retrospective and prospective clinical studies and the development of gender scores. However, the synergistic or opposing effects of sex and gender on cardiovascular traits and on ischaemic heart disease and heart failure mechanisms have not yet been systematically described. Furthermore, specific considerations of sex-related and gender-related factors in gender dysphoria or in heart-brain interactions and their association with cardiovascular disease are still lacking. In this Review, we summarize contemporary evidence on the distinct effects of sex and gender as well as of their interactions on cardiovascular disease and how they favourably or unfavourably influence the pathogenesis, clinical manifestations and treatment responses in patients with ischaemic heart disease or heart failure.
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Affiliation(s)
- Vera Regitz-Zagrosek
- Institute for Gender in Medicine, Charité University Medicine Berlin, Berlin, Germany.
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.
| | - Catherine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
- Department of Cardiology, Inselspital Bern University Hospital, Bern, Switzerland
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17
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Zhu Z, Li Y, Zhang F, Steiger S, Guo C, Liu N, Lu J, Fan G, Wu W, Wu M, Wang H, Xu D, Chen Y, Zhu J, Meng X, Hou X, Anders HJ, Ye J, Zheng Z, Li C, Zhang H. Prediction of Male Coronary Artery Bypass Grafting Outcomes Using Body Surface Area Weighted Left Ventricular End-diastolic Diameter: Multicenter Retrospective Cohort Study. Interact J Med Res 2023; 12:e45898. [PMID: 36951893 PMCID: PMC10131828 DOI: 10.2196/45898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/10/2023] [Accepted: 02/21/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND The presence of a high left ventricular end-diastolic diameter (LVEDD) has been linked to a less favorable outcome in patients undergoing coronary artery bypass grafting (CABG) procedures. However, by taking into consideration the reference of left ventricular size and volume measurements relative to the patient's body surface area (BSA), it has been suggested that the accuracy of the predicting outcomes may be improved. OBJECTIVE We propose that BSA weighted LVEDD (bLVEDD) is a more accurate predictor of outcomes in patients undergoing CABG compared to simply using LVEDD alone. METHODS This study was a comprehensive retrospective cohort study that was conducted across multiple medical centers. The inclusion criteria for this study were patients who were admitted for treatment between October 2016 and May 2021. Only elective surgery patients were included in the study, while those undergoing emergency surgery were not considered. All participants in the study received standard care, and their clinical data were collected through the institutional registry in accordance with the guidelines set forth by the Society of Thoracic Surgeons National Adult Cardiac Database. bLVEDD was defined as LVEDD divided by BSA. The primary outcome was in-hospital all-cause mortality (30 days), and the secondary outcomes were postoperative severe adverse events, including use of extracorporeal membrane oxygenation, multiorgan failure, use of intra-aortic balloon pump, postoperative stroke, and postoperative myocardial infarction. RESULTS In total, 9474 patients from 5 centers under the Chinese Cardiac Surgery Registry were eligible for analysis. We found that a high LVEDD was a negative factor for male patients' mortality (odds ratio 1.44, P<.001) and secondary outcomes. For female patients, LVEDD was associated with secondary outcomes but did not reach statistical differences for morality. bLVEDD showed a strong association with postsurgery mortality (odds ratio 2.70, P<.001), and secondary outcomes changed in parallel with bLVEDD in male patients. However, bLVEDD did not reach statistical differences when fitting either mortality or severer outcomes in female patients. In male patients, the categorical bLVEDD showed high power to predict mortality (area under the curve [AUC] 0.71, P<.001) while BSA (AUC 0.62) and LVEDD (AUC 0.64) both contributed to the risk of mortality but were not as significant as bLVEDD (P<.001). CONCLUSIONS bLVEDD is an important predictor for male mortality in CABG, removing the bias of BSA and showing a strong capability to accurately predict mortality outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT02400125; https://clinicaltrials.gov/ct2/show/NCT02400125.
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Affiliation(s)
- Zhihui Zhu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Medizinische Klinik und Poliklinik IV, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Yuehuan Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Fan Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Stefanie Steiger
- Medizinische Klinik und Poliklinik IV, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Cheng Guo
- Allianz Technology, Allianz, Munich, Germany
| | - Nan Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiakai Lu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Guangpu Fan
- Department of Cardiovascular Surgery, Peking University People's Hospital, Beijing, China
| | - Wenbo Wu
- Department of Cardiovascular Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Mingying Wu
- Department of Cardiovascular Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Huaibin Wang
- Department of Cardiovascular Surgery, Beijing Hospital, Beijing, China
| | - Dong Xu
- Department of Cardiovascular Surgery, Beijing Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yu Chen
- Department of Cardiovascular Surgery, Peking University People's Hospital, Beijing, China
| | - Junming Zhu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xu Meng
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaotong Hou
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hans-Joachim Anders
- Medizinische Klinik und Poliklinik IV, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Jian Ye
- Department of Cardiovascular Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Zhe Zheng
- Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Chenyu Li
- Medizinische Klinik und Poliklinik IV, Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - Haibo Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Vijayalakshmi IB, Nemani L, Kher M, Kumar A. The Gamut of Coronary Artery Disease in Indian Women. INDIAN JOURNAL OF CARDIOVASCULAR DISEASE IN WOMEN 2023. [DOI: 10.25259/mm_ijcdw_404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Coronary artery disease is the leading cause of death among women. Majority of women suffering from CAD have one or more risk factors for CAD in their parents. Women are at higher risk for cardiac events with respect to traditional risk factors including dyslipidemia, hypertension, diabetes, and smoking. Menopause, pregnancy complications, inflammation, anemia, migraines, and depression are important sex-specific novel risk factors for CVD, and it is important that clinicians should be aware of these risks to design strategies for prevention. Education, self-awareness in women, and timely recognition of CAD in women with lifestyle modifications and timely intervention result in better outcomes.
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Affiliation(s)
- I. B. Vijayalakshmi
- Department of Pediatric Cardiology, Super Specialty Hospital (Pradhana Mantri Swasthya Suraksha Yojana), Bengaluru Medical College and Research Institute, Bengaluru, Karnataka, India,
| | - Lalita Nemani
- Department of Cardiology, Nizams Institute of Medical Sciences, Punjagutta, Hyderabad, India,
| | - Monica Kher
- Department of Cardiology, Aster Hospital, Doha, Qatar,
| | - Achukatla Kumar
- Department of Health Research, ICMR, Port Blair, Andaman and Nicobar Islands, India,
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19
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Nurkkala J, Kauko A, Palmu J, Aittokallio J, Niiranen T. Sex differences in coronary artery bypass grafting-related morbidity and mortality. Front Cardiovasc Med 2022; 9:1021363. [DOI: 10.3389/fcvm.2022.1021363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/25/2022] [Indexed: 11/30/2022] Open
Abstract
BackgroundCoronary artery bypass grafting (CABG) is associated with both cardiovascular disease (CVD) and non-CVD traits. In addition, women’s prognosis after coronary events and revascularizations is worse than in men. As the course of CVD in women differs from that of men, we performed a phenome-wide analysis on the sex differences in CABG -related morbidity and mortality.Materials and methodsWe performed an untargeted analysis on the sex differences in predictors and outcomes of CABG. We studied a sample of 176,680 FinnGen participants, including 5,950 individuals who underwent CABG (4,988 men and 962 women) and were followed between 1998 and 2019. Over 1,100 different traits were analyzed for both sexes and the results were adjusted with age, smoking status and BMI. Cox proportional hazards models with sex-trait interactions were used to estimate the associations between (1) traits and incident CABG; and (2) CABG and incident traits.ResultsIn women, CABG was more strongly related to greater increases in risk of diseases such as hypertension, Alzheimer’s, aortic aneurysms, gout, and chronic kidney disease compared to risk increases observed in men (all interaction p-values < 0.03). After CABG, men had 2.5-fold (p = 3.1E−15) and women 6.3-fold (p = 9.4E−08) greater risk of cardiac death compared to same-sex individuals who did not undergo CABG (p for interaction 8.2E−4). Moreover, the risk of death in women remained higher even 12 years after CABG, whereas the long-term risk of death in men was not increased, compared to same-sex individuals who did not undergo CABG.ConclusionThe adverse outcomes after CABG, both quantity and quality, also appear to differ between men and women. In women, CABG is related to greater long-term increases in risk of cardiac death and several other disease states than in men. Consideration should therefore be given to whether women receive adequate long-term post-operative therapy and follow-up as CABG is not associated with equally improved cardiovascular disease prognosis in women than in men.
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Thejasree B, Patnaik S, Maddury J. Gender Specific Coronary Artery Diameters in CT Coronary Angiogram: A Comparative Study in Female and Male Population. INDIAN JOURNAL OF CARDIOVASCULAR DISEASE IN WOMEN 2022. [DOI: 10.25259/mm_ijcdw_438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objectives:
Women show significant in-hospital morbidity and mortality with greater extent of symptoms, poorer post-revascularization outcome with increased restenosis and repeat revascularization after angioplasty, than men. Smaller sized coronary arteries in females can be attributable for this differential outcome, which is also similar in case of Indians, compared to Caucasians. Our aim is to assess the gender-specific difference in coronary arteries using noninvasive Multidetector Computed-Tomography Coronary-Angiogram(CT-CAG) and comparing the same with other racial database.
Materials and Methods:
With Ethics committee approval, present retrospective comparative study conducted in 128CT-CAG scans in 18-45years aged 100 women and 89 men with no atherosclerotic burden excluding pathological coronaries and high calcium score>100. Diameter measurements of proximal (≤10mm) segments of right coronary artery(RCA), left main coronary artery(LMCA), left anterior descending(LAD) and circumflex(LCx) arteries were taken, averaged and compared using 2-sample z-test. Considering the obtained mean diameters of total sample as South-Indian dataset which is then compared with Caucasians dataset taken from previous study.
Results:
Women showed smaller coronary artery diameters compared to men in all the arteries, with greater gender-specific age-adjusted difference in LMCA, followed by LAD, RCA and least in LCX. South-Indians showed statistically significant smaller diameters of all the coronary arteries compared to Caucasians.
Conclusion:
Gender-specific difference among the coronary arteries does exist, with females having smaller dimensions; South-Indians also show smaller diameters. This warrants a clinician for gender-specific approaches during the interventions because of technical difficulties.
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Affiliation(s)
- Bairy Thejasree
- Departments of Radiology and Imageology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India,
| | - Sujata Patnaik
- Departments of Radiology and Imageology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India,
| | - Jyotsna Maddury
- Cardiology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India,
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21
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Vilcant V, Ceron C, Verma G, Zeltser R, Makaryus AN. Inclusion of Under-Represented Racial and Ethnic Groups in Cardiovascular Clinical Trials. Heart Lung Circ 2022; 31:1263-1268. [PMID: 35850910 DOI: 10.1016/j.hlc.2022.06.668] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/02/2022] [Accepted: 06/04/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Non-White racial and ethnic groups have been traditionally under-represented for decades in the field of cardiology, specifically in cardiovascular research studies. This underrepresentation has occurred despite the fact that these racial and ethnic groups have been shown to be at increased risk of cardiovascular disease (CVD). METHODS To assess the trend of representation in mainstream landmark cardiovascular trials, we performed a review of major cardiovascular trials published between 1986 and 2019. Mainstream landmark trials were selected as classified by established cardiology standards. The reported numbers of racial and ethnic participants were assessed within these categorised cardiovascular trials over a continuous time period. RESULTS A total of 1,138,683 patients were assessed from 153 randomised clinical trials. Of these trials, only 56% (n=86) reported information about race. Of note, 99% (n=152) of these trials reported gender. About three-quarters of the trials (77%) were undertaken at least partly in the United States (US). Our results show that the percentage of non-White participants in clinical trials was not significantly different over time (p=0.85), suggesting no significant improvement in non-White racial/ethnic representation. Further analysis of only the US inclusive trials (n=20) also showed no significant improvement in representation (p=0.38). CONCLUSION Only about half of all major cardiovascular landmark trials reported any racial or ethnic information, despite more recent calls over the last 5-10 years for diversity and representation in cardiovascular research studies. Additionally, no significant improvement in inclusion of traditionally under-represented racial and ethnic groups (UREGs) in these trials has occurred over time. Our analysis shows that there is still major work to be done to foster better representation and evaluation of the UREG population in cardiovascular trials.
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Affiliation(s)
| | - Carlos Ceron
- Nassau University Medical Center, East Meadow, NY, USA
| | - Gagan Verma
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY, USA
| | - Roman Zeltser
- Nassau University Medical Center, East Meadow, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY, USA
| | - Amgad N Makaryus
- Nassau University Medical Center, East Meadow, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY, USA.
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22
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Parry M, Van Spall HG, Mullen KA, Mulvagh SL, Pacheco C, Colella TJ, Clavel MA, Jaffer S, Foulds HJ, Grewal J, Hardy M, Price JA, Levinsson AL, Gonsalves CA, Norris CM. The Canadian Women's Heart Health Alliance Atlas on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women - Chapter 6: Sex- and Gender-Specific Diagnosis and Treatment. CJC Open 2022; 4:589-608. [PMID: 35865023 PMCID: PMC9294990 DOI: 10.1016/j.cjco.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/12/2022] [Indexed: 10/26/2022] Open
Abstract
This chapter summarizes the sex- and gender-specific diagnosis and treatment of acute/unstable presentations and nacute/stable presentations of cardiovascular disease in women. Guidelines, scientific statements, systematic reviews/meta-analyses, and primary research studies related to diagnosis and treatment of coronary artery disease, cerebrovascular disease (stroke), valvular heart disease, and heart failure in women were reviewed. The evidence is summarized as a narrative, and when available, sex- and gender-specific practice and research recommendations are provided. Acute coronary syndrome presentations and emergency department delays are different in women than they are in men. Coronary angiography remains the gold-standard test for diagnosis of obstructive coronary artery disease. Other diagnostic imaging modalities for ischemic heart disease detection (eg, positron emission tomography, echocardiography, single-photon emission computed tomography, cardiovascular magnetic resonance, coronary computed tomography angiography) have been shown to be useful in women, with their selection dependent upon both the goal of the individualized assessment and the testing resources available. Noncontrast computed tomography and computed tomography angiography are used to diagnose stroke in women. Although sex-specific differences appear to exist in the efficacy of standard treatments for diverse presentations of acute coronary syndrome, many cardiovascular drugs and interventions tested in clinical trials were not powered to detect sex-specific differences, and knowledge gaps remain. Similarly, although knowledge is evolving about sex-specific difference in the management of valvular heart disease, and heart failure with both reduced and preserved ejection fraction, current guidelines are lacking in sex-specific recommendations, and more research is needed.
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Affiliation(s)
- Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Harriette G.C. Van Spall
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, Research Institute of St. Joe’s, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Kerri-Anne Mullen
- Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Sharon L. Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Christine Pacheco
- Hôpital Pierre-Boucher, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Tracey J.F. Colella
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- KITE, Toronto Rehab, University Health Network, Toronto, Ontario, Canada
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de pneumologie de Québec— Université Laval, Quebec City, Quebec, Canada
| | - Shahin Jaffer
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Heather J.A. Foulds
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jasmine Grewal
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marsha Hardy
- Canadian Women's Heart Health Alliance, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | | | | | - Colleen M. Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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23
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Thomas EG, Rhodius-Meester H, Exalto L, Peters SAE, van Bloemendaal L, Ponds R, Muller M. Sex-Specific Associations of Diabetes With Brain Structure and Function in a Geriatric Population. Front Aging Neurosci 2022; 14:885787. [PMID: 35837485 PMCID: PMC9273850 DOI: 10.3389/fnagi.2022.885787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/20/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Globally, women with dementia have a higher disease burden than men with dementia. In addition, women with diabetes especially are at higher risk for cognitive impairment and dementia compared to men with diabetes. Differences in the influence of diabetes on the cerebral vasculature and brain structure may contribute to these sex-specific differences. We examined sex-specific patterns in the relationship between diabetes and brain structure, as well as diabetes and cognitive function. Methods In total, 893 patients [age 79 ± 6.6 years, 446 (50%) women] from the Amsterdam Ageing Cohort with available data on brain structures (assessed by an MRI or CT scan) and cognitive function were included. All patients underwent a thorough standardized clinical and neuropsychological assessment (including tests on memory, executive functioning, processing speed, language). Brain structure abnormalities were quantified using visual scales. Results Cross-sectional multivariable regression analyses showed that diabetes was associated with increased incidence of cerebral lacunes and brain atrophy in women (OR 2.18 (1.00–4.72) but not in men. Furthermore, diabetes was associated with decreased executive function, processing speed and language in women [B −0.07 (0.00–0.13), −0.06 (0.02–0.10) and −0.07 (0.01–0.12) resp.] but not in men. Conclusions Diabetes is related to increased risk of having lacunes, brain atrophy and impaired cognitive function in women but not in men. Further research is required to understand the time trajectory leading up to these changes and to understand the mechanisms behind them in order to improve preventive health care for both sexes.
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Affiliation(s)
- Elias G. Thomas
- Department of Internal Medicine, Geriatrics Section, Amsterdam Cardiovascular Science, Amsterdam University Medical Centre, Amsterdam UMC, Amsterdam, Netherlands
- Department of Internal Medicine, Amsterdam Public Health Institute, Amsterdam UMC, Amsterdam, Netherlands
- *Correspondence: Elias G. Thomas
| | - Hanneke Rhodius-Meester
- Department of Internal Medicine, Geriatrics Section, Amsterdam Cardiovascular Science, Amsterdam University Medical Centre, Amsterdam UMC, Amsterdam, Netherlands
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, VU University Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Lieza Exalto
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Sanne A. E. Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- The George Institute for Global Health, Imperial College London, London, United Kingdom
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Liselotte van Bloemendaal
- Department of Internal Medicine, Geriatrics Section, Amsterdam Cardiovascular Science, Amsterdam University Medical Centre, Amsterdam UMC, Amsterdam, Netherlands
| | - Rudolf Ponds
- Department of Medical Psychology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Majon Muller
- Department of Internal Medicine, Geriatrics Section, Amsterdam Cardiovascular Science, Amsterdam University Medical Centre, Amsterdam UMC, Amsterdam, Netherlands
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24
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Ikonomidis JS. The recurring theme of gender difference in cardiac surgical outcomes. J Card Surg 2022; 37:2661-2662. [PMID: 35652890 DOI: 10.1111/jocs.16657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022]
Affiliation(s)
- John S Ikonomidis
- Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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25
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Morjan M, Mestres CA, Lavanchy I, Gerçek M, Van Hemelrijck M, Sromicki J, Vogt P, Reser D. The impact of age and sex on in-hospital outcomes in acute type A aortic dissection surgery. J Thorac Dis 2022; 14:2011-2021. [PMID: 35813713 PMCID: PMC9264052 DOI: 10.21037/jtd-21-1863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 04/24/2022] [Indexed: 12/26/2022]
Abstract
Background Older age and female sex are thought to be risk factors for adverse outcomes after repair of acute type A aortic dissection (AAAD). The aim of this study is to analyze age- and sex-related outcomes in patients undergoing AAAD repair. Methods Retrospective analysis of patients undergoing emergency AAAD repair. Patients were divided in Group A, patients aged ≥75 years and Group B <75. Intraoperative and postoperative data were compared between groups before and after propensity score matching. Sex differences were analyzed by age group. Results Between January 2006 and December 2018, 638 patients underwent emergency AAAD repair. Group A included 143 patients (22.4%), Group B 495 (77.6%). More patients in Group A presented with circulatory collapse (Penn C 26.6% vs. 9.7%, P=0.001) while Group B presented with circulatory collapse-branch malperfusion (Penn BC 29.3% vs. 15.4% P=0.001). After propensity score matching, Group B patients received more complex aortic root (33.6% vs. 23.2%, P=0.019) and concomitant bypass surgery (12.3% vs. 6.3%, P=0.042). There was no significant difference in in-hospital mortality between age groups (18% vs. 12% P=0.12). In Group B, in-hospital mortality was significantly higher in females (22.2% vs. 8.2%, P=0.028). Differences in mortality disappeared after the age of 75 (18.3% vs. 19.4% P=0.87). Conclusions Morbidity and mortality are comparable between patients under and over 75 years after AAAD repair. Female patients <75 had higher in-hospital mortality than their male counterparts.
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Affiliation(s)
- Mohammed Morjan
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland.,Clinic for Cardiovascular Surgery, Heart Center Duisburg, Duisburg, Germany
| | - Carlos A Mestres
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Isabel Lavanchy
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Mustafa Gerçek
- Clinic for Cardiovascular Surgery, Heart Center Duisburg, Duisburg, Germany
| | | | - Juri Sromicki
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Paul Vogt
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Diana Reser
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland.,Herzklinik Hirslanden, Zürich, Switzerland
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26
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Wang E, Wang Y, Hu S, Yuan S. Impact of gender differences on hemostasis in patients after coronary artery bypass grafts surgeries in the context of tranexamic acid administration. J Cardiothorac Surg 2022; 17:123. [PMID: 35598028 PMCID: PMC9123662 DOI: 10.1186/s13019-022-01874-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/30/2022] [Indexed: 11/10/2022] Open
Abstract
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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Affiliation(s)
- Enshi Wang
- Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Xicheng District, Beijing, 100037, China
| | - Yang Wang
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Xicheng District, Beijing, 100037, China
| | - Shengshou Hu
- Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Xicheng District, Beijing, 100037, China.
| | - Su Yuan
- Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Xicheng District, Beijing, 100037, China.
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27
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Chang FC, Chen SW, Chan YH, Lin CP, Wu VCC, Cheng YT, Chen DY, Hung KC, Chu PH, Chou AH. Sex differences in risks of in-hospital and late outcomes after cardiac surgery: a nationwide population-based cohort study. BMJ Open 2022; 12:e058538. [PMID: 35110325 PMCID: PMC8811586 DOI: 10.1136/bmjopen-2021-058538] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Outcomes of sex differences in major cardiac surgery remain controversial. A comprehensive understanding of sex differences in major adult cardiac surgery could provide better knowledge of risk factors, management strategy and short-term or long-term outcomes. The present study aimed to investigate sex differences in the risks of outcomes of major cardiac surgeries and subgroup analyses of different valve types. DESIGN Population-based nationwide cohort study. SETTING Data were obtained from National Health Insurance Research Database (NHIRD) in Taiwan. PARTICIPANTS A total of 66 326 adult patients (age ≥20 years; 30.3% women) who underwent a first major cardiac surgery (isolated coronary artery bypass graft (CABG), isolated valve or concomitant bypass/valve) from 2000 to 2013 were identified via Taiwan NHIRD. MAIN OUTCOME MEASURES Outcomes of primary interest were in-hospital death and all-cause mortality during follow-up period. Propensity score matching was conducted as a secondary analysis for the sensitivity test. RESULTS Women who underwent isolated CABG tended to have greater risks of both in-hospital (OR 1.37; 95% CI 1.26 to 1.49) and late outcomes (HR 1.26; 95% CI 1.22 to 1.31). Women after concomitant CABG/valve also had a greater in-hospital (OR 1.19; 95% CI 1.01 to 1.40) and long-term mortality (HR 1.14; 95% CI 1.05 to 1.24). Women after isolated mitral valve repair have a non-favourable outcome of in-hospital mortality (OR 1.70; 95% CI 1.01 to 2.87). Women who did not receive an isolated aortic valve replacement had more favourable all-cause mortality outcome (HR 0.90; 95% CI 0.84 to 0.96). Secondary analysis in the propensity score-matching cohort demonstrated results similar to the primary analysis. CONCLUSIONS Female patients who underwent procedures involving CABG (with or without concurrent valvular intervention) had generally worse outcomes. However, the results of isolated valve surgery were variable on the basis of the type of intervened valve.
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Affiliation(s)
- Feng-Cheng Chang
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Shao-Wei Chen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Yi-Hsin Chan
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Chia-Pin Lin
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Victor Chien-Chia Wu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Yu-Ting Cheng
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Dong-Yi Chen
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Kuo-Chun Hung
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - An-Hsun Chou
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
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28
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Lander BS, Layton AM, Garofano RP, Schwartz A, Engel DJ, Bello NA. Average Exercise Capacity in Men and Women >75 Years of Age Undergoing a Bruce Protocol Exercise Stress Test. Am J Cardiol 2022; 164:21-26. [PMID: 34844736 PMCID: PMC8727541 DOI: 10.1016/j.amjcard.2021.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/11/2021] [Accepted: 10/15/2021] [Indexed: 02/03/2023]
Abstract
Exercise stress testing is routinely performed to evaluate suspected coronary artery disease in older adults. However, the available data to predict and compare relative exercise capacity in the general population were developed using predominantly younger, healthy cohorts with few or no women. This study aimed to describe the exercise capacity of patients older than 75 years who underwent a clinically indicated Bruce protocol exercise stress test. This was a retrospective, cross-sectional study of 2,041 consecutive patients older than 75 years who performed a Bruce protocol exercise stress echocardiogram that was terminated because of maximal effort without ischemia at Columbia University Medical Center between April 10, 2009, and July 30, 2020. The analytic sample included 2,041 exercise stress tests in 786 women (median [interquartile range] age 79 [77 to 81] years) and 1,255 men (median [interquartile range] age 79 [77 to 82] years). Cardiovascular risk factors and clinical coronary disease were common and more prevalent in men than women. The median exercise time for men aged 76 to 80 years was 7:22 (minutes:seconds) and for women was 6:00 and significantly decreased in both genders as age increased (p <0.001). The mean (SD) METs achieved for women and men were 6.5 (1.6) and 7.7 (1.7), respectively. Most women (85%) and men (95%) completed the first stage, whereas only 32% of women and 64% of men completed the second stage. It was uncommon for women (3%) or men (15%) to complete the third stage. Fewer than 1% of patients completed the fourth stage, and none completed the fifth stage. At all ages, women had a lower exercise capacity than men. These data allow physicians to compare the exercise capacity of older patients who underwent a Bruce protocol exercise stress test more accurately to a representative sample of similarly aged adults.
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Affiliation(s)
- Bradley S. Lander
- Department of Medicine, Seymour, Paul and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Aimee M. Layton
- Cardiopulmonary Exercise Laboratory, Department of Pediatrics, Division of Pediatric Cardiology, Columbia University, New York, NY, USA
| | - Robert P. Garofano
- Cardiopulmonary Exercise Laboratory, Department of Pediatrics, Division of Pediatric Cardiology, Columbia University, New York, NY, USA
| | - Allan Schwartz
- Department of Medicine, Seymour, Paul and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - David J. Engel
- Department of Medicine, Seymour, Paul and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Natalie A. Bello
- Department of Medicine, Seymour, Paul and Gloria Milstein Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA.,Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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29
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Zwischenberger BA, Jawitz OK, Lawton JS. Coronary surgery in women: How can we improve outcomes. JTCVS Tech 2021; 10:122-128. [PMID: 34977714 PMCID: PMC8691860 DOI: 10.1016/j.xjtc.2021.09.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 10/27/2022] Open
Affiliation(s)
- Brittany A. Zwischenberger
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Baltimore, Md
| | - Oliver K. Jawitz
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Baltimore, Md
| | - Jennifer S. Lawton
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Md
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Bell J, Sartipy U, Holzmann MJ, Hertzberg D. The Association Between Acute Kidney Injury and Mortality After Coronary Artery Bypass Grafting Was Similar in Women and Men. J Cardiothorac Vasc Anesth 2021; 36:962-970. [PMID: 34969562 DOI: 10.1053/j.jvca.2021.11.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/11/2021] [Accepted: 11/22/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess sex differences in short- and long-term mortality in patients who develop acute kidney injury (AKI) after coronary artery bypass grafting (CABG). DESIGN An observational cohort study. SETTING A multicenter, nationwide, population-based, observational cohort study. PARTICIPANTS All patients (n = 32,013) who underwent primary nonemergent isolated CABG in Sweden between January 1, 2003, and December 31, 2013. INTERVENTIONS AKI and its association with 90-day mortality were analyzed using logistic regression. AKI and its association with long-term mortality were analyzed using Cox regression analysis. MEASUREMENTS AND MAIN RESULTS AKI was defined as an absolute increase by 26 µmol/L or a relative increase by 50% postoperatively compared with the preoperative serum creatinine concentration. Ninety-day mortality was defined as death by any cause within 90 days after surgery. Long-term mortality was defined as death by any cause from day 91 after surgery to the end of the study period. In total, 13.9% of women and 14.4% of men developed AKI after CABG. The multivariate-adjusted odds ratio (95% confidence interval [CI]) for death within 90 days in patients with AKI compared to those without AKI was 5.1 (3.6-7.2) and 5.2 (4.2-6.6) in women and men, respectively (p for interaction = 0.74). The multivariate-adjusted hazard ratio (95% CI) for long-term death in those with AKI compared to those without AKI was 1.4 (1.2-1.7) and 1.3 (1.2-1.4) in women and men, respectively (p for interaction = 0.27). CONCLUSION AKI after CABG was associated with a similar increase in 90-day and long-term mortality in both women and men.
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Affiliation(s)
- Julia Bell
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Ulrik Sartipy
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Martin J Holzmann
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Functional Area of Emergency Medicine, Huddinge, Karolinska University Hospital, Stockholm, Sweden
| | - Daniel Hertzberg
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Stockholm, Sweden; Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
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Dixon LK, Di Tommaso E, Dimagli A, Sinha S, Sandhu M, Benedetto U, Angelini GD. Impact of sex on outcomes after cardiac surgery: A systematic review and meta-analysis. Int J Cardiol 2021; 343:27-34. [PMID: 34520795 DOI: 10.1016/j.ijcard.2021.09.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/28/2021] [Accepted: 09/07/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Despite advances in cardiac surgery, observational studies suggest that females have poorer post-operative outcomes than males. This study is the first to review sex related outcomes following both coronary artery bypass graft (CABG) and valve surgery with or without combined CABG. METHODS We identified 30 primary research articles reporting either short-term mortality (in-hospital/30 day), long-term mortality, and post-operative stroke, sternal wound infection and myocardial infarction (MI) in both sexes following CABG and valve surgery with or without combined CABG. Reported adjusted odds/hazard ratio were pooled using an inverse variance model. RESULTS Females undergoing CABG and combined valve and CABG surgery were at higher risk of short-term mortality (odds ratio (OR) 1.40; 95% confidence interval (CI) 1.32-1.49; I2 = 79%) and post-operative stroke (OR 1.2; CI 1.07-1.34; I2 = 90%) when compared to males. However, for isolated AVR, there was no difference found (OR 1.19; 95% CI 0.74-1.89). There was no increased risk in long-term mortality (OR 1.04; 95% CI: 0.93-1.16; I2 = 82%), post-operative MI (OR 1.22; 95%CI: 0.89-1.67; I2 = 60%) or deep sternal wound infection (OR 0.92; 95%CI: 0.65-1.03, I2 = 87%). No evidence of publication bias or small study effect was found. CONCLUSION Females are at a greater risk of short-term mortality and post-operative stroke than males following CABG and valve surgery combined with CABG. However, there is no difference for Isolated AVR. Long-term mortality is equivalent in both sexes. PROSPERO Registration: CRD42021244603.
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Affiliation(s)
- Lauren Kari Dixon
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK.
| | - Ettorino Di Tommaso
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK.
| | - Arnaldo Dimagli
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK.
| | - Shubhra Sinha
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK.
| | - Manraj Sandhu
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK.
| | - Umberto Benedetto
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK.
| | - Gianni D Angelini
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, UK.
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Schamroth Pravda N, Karny-Rahkovich O, Shiyovich A, Schamroth Pravda M, Rapeport N, Vaknin-Assa H, Eisen A, Kornowski R, Porter A. Coronary Artery Disease in Women: A Comprehensive Appraisal. J Clin Med 2021; 10:jcm10204664. [PMID: 34682787 PMCID: PMC8541551 DOI: 10.3390/jcm10204664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/02/2021] [Accepted: 10/09/2021] [Indexed: 01/16/2023] Open
Abstract
Coronary artery disease (CAD) is a significant cause of illness and death amongst women. The pathophysiology, manifestations, and outcomes of CVD and CAD differ between sexes. These sex differences remain under-recognized. The aim of this review is to highlight and raise awareness of the burden and unique aspects of CAD in women. It details the unique pathophysiology of CAD in women, cardiovascular risk factors in women (both traditional and sex-specific), the clinical presentation of CAD in women, and the range of disease in obstructive and non-obstructive CAD in women.
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Affiliation(s)
- Nili Schamroth Pravda
- Department of Cardiology, Rabin Medical Center, Petach Tikva 49100, Israel; (O.K.-R.); (A.S.); (H.V.-A.); (A.E.); (R.K.); (A.P.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
- Correspondence: ; Tel.: +972-544476243
| | - Orith Karny-Rahkovich
- Department of Cardiology, Rabin Medical Center, Petach Tikva 49100, Israel; (O.K.-R.); (A.S.); (H.V.-A.); (A.E.); (R.K.); (A.P.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
| | - Arthur Shiyovich
- Department of Cardiology, Rabin Medical Center, Petach Tikva 49100, Israel; (O.K.-R.); (A.S.); (H.V.-A.); (A.E.); (R.K.); (A.P.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
| | | | | | - Hana Vaknin-Assa
- Department of Cardiology, Rabin Medical Center, Petach Tikva 49100, Israel; (O.K.-R.); (A.S.); (H.V.-A.); (A.E.); (R.K.); (A.P.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
| | - Alon Eisen
- Department of Cardiology, Rabin Medical Center, Petach Tikva 49100, Israel; (O.K.-R.); (A.S.); (H.V.-A.); (A.E.); (R.K.); (A.P.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva 49100, Israel; (O.K.-R.); (A.S.); (H.V.-A.); (A.E.); (R.K.); (A.P.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
| | - Avital Porter
- Department of Cardiology, Rabin Medical Center, Petach Tikva 49100, Israel; (O.K.-R.); (A.S.); (H.V.-A.); (A.E.); (R.K.); (A.P.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
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Update: Gender differences in CABG outcomes-Have we bridged the gap? PLoS One 2021; 16:e0255170. [PMID: 34525123 PMCID: PMC8443029 DOI: 10.1371/journal.pone.0255170] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/11/2021] [Indexed: 11/19/2022] Open
Abstract
Background Appreciation of unique presentation, patterns and underlying pathophysiology of coronary artery disease in women has driven gender based risk stratification and risk reduction efforts over the last decade. Data regarding whether these advances have resulted in unequivocal improvements in outcomes of CABG in women is conflicting. The objective of our study was to assess gender differences in post-operative outcomes following CABG. Methods Retrospective analyses of institutional data housed in the Society of Thoracic Surgeons (STS) database for patients undergoing CABG between 2002 and 2020 were conducted. Multivariable regression analysis was conducted to investigate gender differences in post-operative outcomes. P-values were adjusted using Bonferroni correction to reduce type-I errors. Results Our final cohort of 6,250 patients had fewer women than men (1,339 vs. 4,911). more women were diabetic (52.0% vs. 41.2%, p<0.001) and hypertensive (89.1% vs. 84.0%, p<0.001). Women had higher adjusted odds of developing ventilator dependence >48 hours (OR: 1.65 [1.21, 2.45], p = 0.002) and cardiac readmissions (OR: 1.56 [1.27, 2.30], p = 0.003). After adjustment for comorbidity burden, mortality rates in women were comparable to those of age-matched men. Conclusion The findings of our study indicate that despite apparent reduction of differences in mortality, the burden of postoperative morbidity is still high among women.
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Dani SS, Minhas AMK, Arshad A, Krupica T, Goel SS, Virani SS, Sharma G, Blankstein R, Blaha MJ, Al-Kindi SG, Nasir K, Khan SU. Trends in Characteristics and Outcomes of Hospitalized Young Patients Undergoing Coronary Artery Bypass Grafting in the United States, 2004 to 2018. J Am Heart Assoc 2021; 10:e021361. [PMID: 34459230 PMCID: PMC8649273 DOI: 10.1161/jaha.121.021361] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Data are limited about young adults' characteristics and outcomes undergoing coronary artery bypass grafting (CABG). Methods and Results We used the National Inpatient Sample database to identify adults aged 18 to 45 years who underwent CABG between 2004 and 2018. The data were weighted to generate national estimates of the entire US hospitalized population. We identified 110 463 CABG cases, equivalent to 62.2 per 1 000 000 person‐years; 27.1% were women, and 70.2% were White adults. Overall, annual CABG volume per 1 000 000 significantly decreased from 87.3 in 2004 to 45.7 in 2018. The prevalence of obesity, diabetes mellitus, hypertension, drug abuse, and chronic medical conditions increased over time. Overall, inpatient mortality was 1.76%; ST‐segment–elevation myocardial infarction, non–ST‐segment–elevation myocardial infarction, heart failure, peripheral vascular disease, renal failure, and valvular surgery were associated with higher inpatient mortality. Women had higher inpatient mortality than men (2.29% versus 1.57%), and Black patients had higher deaths than White patients (2.86% versus 1.58%). Inpatient mortality remained stable overall, according to sex, race, or clinical indication of CABG. However, the mean length of stay (8.4 days in 2004 to 9.5 days in 2018) and inflation‐adjusted cost of care ($40 522.8 in 2004 to $52 434.2 in 2018) significantly increased during the study period. Conclusions Despite the increased burden of cardiometabolic risk factors, the inpatient mortality in young adults undergoing CABG remained stable during the last 15 years. However, CABG volumes have decreased, but length of stay and inflation‐adjusted costs have increased over time.
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Affiliation(s)
- Sourbha S Dani
- Division of Cardiology Lahey Hospital and Medical CenterBeth Israel Lahey Health Burlington MA
| | | | - Adeel Arshad
- Department of Medical Oncology Ohio State University Comprehensive Cancer Care Center Columbus OH
| | - Troy Krupica
- Department of Medicine West Virginia University Morgantown WV
| | - Sachin S Goel
- Department of Cardiology Houston Methodist DeBakey Heart & Vascular Center Houston TX
| | - Salim S Virani
- Michael E. DeBakey Veterans Affair Medical Center & Section of Cardiovascular Research Department of Medicine Baylor College of Medicine Houston TX
| | - Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University Baltimore MD
| | - Ron Blankstein
- Cardiovascular Division Brigham and Women's Hospital Boston MA
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University Baltimore MD
| | - Sadeer G Al-Kindi
- Harrington Heart and Vascular InstituteUniversity Hospitals and Case Western Reserve University Cleveland OH
| | - Khurram Nasir
- Department of Cardiology Houston Methodist DeBakey Heart & Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Houston TX
| | - Safi U Khan
- Department of Cardiology Houston Methodist DeBakey Heart & Vascular Center Houston TX
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Ter Woorst JF, Olsthoorn JR, Houterman S, van Straten BHM, Soliman-Hamad MA. Sex Difference in Long-Term Survival After Coronary Artery Bypass Grafting Is Age-Dependent. J Cardiothorac Vasc Anesth 2021; 36:1288-1295. [PMID: 34583854 DOI: 10.1053/j.jvca.2021.08.104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Women undergoing coronary artery bypass grafting (CABG) demonstrate higher rates of postoperative morbidity and mortality than men. The aim of this study was to compare the patient profile and long-term outcomes of men and women undergoing isolated CABG. DESIGN A retrospective patient record study and propensity score-matched analysis. SETTING This single-center study was performed at Catharina Hospital in Eindhoven, The Netherlands. PARTICIPANTS The study comprised 17,483 patients, of whom 13,564 (77.6%) were men and 3,919 (22.4%) were women. INTERVENTIONS Coronary artery bypass grafting was performed between January 1998 and December 2015. MEASUREMENTS AND MAIN RESULTS The mean follow-up period was 8.8 ± 5.0 years. Women were older than men (67.7 ± 9.4 years v 63.9 ± 9.6 years, p < 0.001) and had lower preoperative hemoglobin levels. Early mortality (30-day) (2.8% v 1.9%; p < 0.001) and one-year mortality (5.2% v 3.8%; p < 0.001) rates were significantly higher in women than in men. Women demonstrated worse long-term survival than men only in the population younger than 70 years. After propensity score matching, female sex was not identified as an independent risk factor for long-term survival. CONCLUSIONS In the patient population, propensity score-matched analysis showed that female sex was not an independent risk factor for long-term survival after CABG. Poorer survival in women after CABG only was observed in patients <70 years of age.
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Affiliation(s)
- Joost F Ter Woorst
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Jules R Olsthoorn
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Saskia Houterman
- Department of Research & Education, Catharina Hospital, Eindhoven, the Netherlands
| | - Bart H M van Straten
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, the Netherlands
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Khandelwal A, Bakir M, Bezaire M, Costello B, Gomez JMD, Hoover V, Nazir NT, Nichols K, Reisenberg A, Rao A, Sanghani R, Tracy M, Volgman AS. Managing Ischemic Heart Disease in Women: Role of a Women's Heart Center. Curr Atheroscler Rep 2021; 23:56. [PMID: 34345945 PMCID: PMC8331213 DOI: 10.1007/s11883-021-00956-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Heart centers for women (HCW) were developed due to the rising cardiovascular morbidity and mortality in women in the United States in the early 1990s. Our review encompasses the epidemiology, risk factors, diagnostic strategies, treatments, and the role of HCW in managing women with ischemic heart disease (IHD). RECENT FINDINGS HCW use a multidisciplinary team to manage women with IHD. Due to the paucity of randomized controlled trials investigating various manifestations of IHD, some treatments are not evidence-based such as those for coronary microvascular dysfunction and spontaneous coronary artery dissection. Sex-specific risk factors have been identified and multimodality cardiac imaging is improving in diagnosing IHD in women. Treatments are being studied to help improve symptoms and outcomes in women with IHD. There has been progress in the care of women with IHD. HCW can be instrumental in treating women with IHD, doing research, and being a source of research study participants.
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Affiliation(s)
- Abha Khandelwal
- Division of Cardiology, Women’s Heart Health, Stanford University, Palo Alto, CA USA
| | - May Bakir
- Division of Cardiology, Women’s Heart Health Center, Loyola University, Chicago, IL USA
| | - Meghan Bezaire
- Rush Heart Center for Women, Division of Cardiology, Rush University Medical Center, Chicago, IL USA
| | - Briana Costello
- Center for Women’s Heart & Vascular Health, Texas Heart Institute, and Baylor St. Luke’s Medical Center Hospital, Houston, TX USA
| | | | - Valerie Hoover
- Department of Psychology, Stanford University, Palo Alto, CA USA
| | - Noreen T. Nazir
- Division of Cardiology, Department of Medicine, University of Illinois, Chicago, Chicago USA
| | - Katherine Nichols
- Division of Cardiology, Massachusetts General Hospital, Harvard University, Boston, MA USA
| | - Amy Reisenberg
- Stanford Healthcare, Stanford University, Palo Alto, CA USA
| | - Anupama Rao
- Division of Cardiology, Rush University Medical Center, Chicago, IL USA
| | - Rupa Sanghani
- Rush Heart Center for Women, Division of Cardiology, Rush University Medical Center, Chicago, IL USA
| | - Melissa Tracy
- Rush Heart Center for Women, Division of Cardiology, Rush University Medical Center, Chicago, IL USA
| | - Annabelle Santos Volgman
- Rush Heart Center for Women, Division of Cardiology, Rush University Medical Center, Chicago, IL USA
- Chicago, USA
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Gaudino M, Di Franco A, Alexander JH, Bakaeen F, Egorova N, Kurlansky P, Boening A, Chikwe J, Demetres M, Devereaux PJ, Diegeler A, Dimagli A, Flather M, Hameed I, Lamy A, Lawton JS, Reents W, Robinson NB, Audisio K, Rahouma M, Serruys PW, Hara H, Taggart DP, Girardi LN, Fremes SE, Benedetto U. Sex differences in outcomes after coronary artery bypass grafting: a pooled analysis of individual patient data. Eur Heart J 2021; 43:18-28. [PMID: 34338767 DOI: 10.1093/eurheartj/ehab504] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/13/2021] [Accepted: 07/15/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Data suggest that women have worse outcomes than men after coronary artery bypass grafting (CABG), but results have been inconsistent across studies. Due to the large differences in baseline characteristics between sexes, suboptimal risk adjustment due to low-quality data may be the reason for the observed differences. To overcome this limitation, we undertook a systematic review and pooled analysis of high-quality individual patient data from large CABG trials to compare the adjusted outcomes of women and men. METHODS AND RESULTS The primary outcome was a composite of all-cause mortality, myocardial infarction (MI), stroke, and repeat revascularization (major adverse cardiac and cerebrovascular events, MACCE). The secondary outcome was all-cause mortality. Multivariable mixed-effect Cox regression was used. Four trials involving 13 193 patients (10 479 males; 2714 females) were included. Over 5 years of follow-up, women had a significantly higher risk of MACCE [adjusted hazard ratio (HR) 1.12, 95% confidence interval (CI) 1.04-1.21; P = 0.004] but similar mortality (adjusted HR 1.03, 95% CI 0.94-1.14; P = 0.51) compared to men. Women had higher incidence of MI (adjusted HR 1.30, 95% CI 1.11-1.52) and repeat revascularization (adjusted HR 1.22, 95% CI 1.04-1.43) but not stroke (adjusted HR 1.17, 95% CI 0.90-1.52). The difference in MACCE between sexes was not significant in patients 75 years and older. The use of off-pump surgery and multiple arterial grafting did not modify the difference between sexes. CONCLUSIONS Women have worse outcomes than men in the first 5 years after CABG. This difference is not significant in patients aged over 75 years and is not affected by the surgical technique.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA
| | - Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA
| | - John H Alexander
- Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, 40 Duke Medicine Cir, Durham, NC 27710, USA
| | - Faisal Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Carnegie Ave, Cleveland, OH 44103, USA
| | - Natalia Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, USA
| | - Paul Kurlansky
- Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Medical Center, 622 W 168th St, New York, NY 10032, USA
| | - Andreas Boening
- Department of Cardiovascular Surgery, Justus-Liebig University Gießen, , Ludwigstraße 23, Gießen 35390, Germany
| | - Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd #2900A, Los Angeles, CA 90048, USA
| | - Michelle Demetres
- Samuel J. Wood Library and C.V. Starr Biomedical Information Center, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA
| | - Philip J Devereaux
- Population Health Research Institute, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Anno Diegeler
- Department Cardiac Surgery, Cardiovascular Center Bad Neustadt/Saale, Von-Guttenberg-Straße 11, Bad Neustadt/Saale 97616, Germany
| | - Arnaldo Dimagli
- Bristol Heart Institute, University of Bristol, Terrell St, Bristol BS2 8ED, UK
| | - Marcus Flather
- Research and Development Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Ln, Norwich NR4 7UY, UK
| | - Irbaz Hameed
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA
| | - Andre Lamy
- Population Health Research Institute, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Jennifer S Lawton
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA
| | - Wilko Reents
- Department Cardiac Surgery, Cardiovascular Center Bad Neustadt/Saale, Von-Guttenberg-Straße 11, Bad Neustadt/Saale 97616, Germany
| | - N Bryce Robinson
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA
| | - Katia Audisio
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA
| | - Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, University Rd, Galway, Ireland
| | - Hironori Hara
- Department of Cardiology, National University of Ireland, University Rd, Galway, Ireland
| | - David P Taggart
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford OX1 2JD, UK
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA
| | - Stephen E Fremes
- Schulich Heart Centre Sunnybrook Health Sciences Centre, University of Toronto, Hospital Road, Toronto, ON M4N 3M5, Canada
| | - Umberto Benedetto
- Bristol Heart Institute, University of Bristol, Terrell St, Bristol BS2 8ED, UK
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Jawitz OK, Lawton JS, Thibault D, O'Brien S, Higgins RSD, Schena S, Vemulapalli S, Thomas KL, Zwischenberger BA. Sex Differences in Coronary Artery Bypass Grafting Techniques: A STS Database Analysis. Ann Thorac Surg 2021; 113:1979-1988. [PMID: 34280377 DOI: 10.1016/j.athoracsur.2021.06.039] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/04/2021] [Accepted: 06/08/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Females with coronary artery disease (CAD) have inferior outcomes compared with males, including higher mortality following coronary artery bypass grafting (CABG). We aimed to evaluate the association of female sex with the use of guideline-concordant CABG revascularization techniques. METHODS The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database was queried for adult patients who underwent first-time isolated CABG in the US from 2011-2019. The association between female sex and the odds of (1) receiving a left internal mammary artery (LIMA) graft for revascularization of the left anterior descending (LAD) artery, (2) undergoing complete revascularization, and (3) undergoing multi-arterial grafting was assessed, adjusting for procedural anatomy. RESULTS Among 1,212,487 patients meeting inclusion criteria, 75% were male (n=911,178) and 25% were female (n=301,309). Female sex was associated with lower unadjusted rates of revascularization with an IMA (93.9% vs 95.9%, P<.001), bilateral IMA (2.9% vs 5.6%, P<.001) or radial artery (3.2% vs 5.6%, P<.001) graft. After adjustment, females had a lower odds than males of receiving a LIMA graft to the LAD (adjusted odds ratio [AOR] 0.79, 95% CI 0.75-0.83, P<.001), undergoing complete revascularization (AOR 0.86, 95% CI 0.83-0.90, P<.001), and undergoing multi-arterial grafting (AOR 0.78, 95% CI 0.75-0.81, P<.001). CONCLUSIONS Female sex was associated with a 14-22% lower odds of undergoing guideline concordant revascularization including LIMA to LAD grafting, multi-arterial grafting, and complete revascularization. Further investigation is necessary to determine why revascularization approaches differ by sex and to what degree sex disparities in CAD outcomes are due to surgical approach.
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Affiliation(s)
- Oliver K Jawitz
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
| | - Jennifer S Lawton
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Dylan Thibault
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Sean O'Brien
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Robert S D Higgins
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Stefano Schena
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA; Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Kevin L Thomas
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA; Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Brittany A Zwischenberger
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
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Brainin P, Lindberg S, Olsen FJ, Pedersen S, Iversen A, Galatius S, Fritz-Hansen T, Gislason G, Søgaard P, Møgelvang R, Biering-Sørensen T. Early systolic lengthening by speckle tracking echocardiography predicts outcome after coronary artery bypass surgery. IJC HEART & VASCULATURE 2021; 34:100799. [PMID: 34124339 PMCID: PMC8175274 DOI: 10.1016/j.ijcha.2021.100799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Early systolic lengthening (ESL), a paradoxical stretch of myocardial fibers, has been linked to loss of myocardial viability and contractile dysfunction. We assessed the long-term prognostic potential of ESL in coronary artery bypass graft (CABG) patients. METHODS We retrospectively included patients (n = 709; mean age 68 years; 85% men) who underwent speckle tracking echocardiography (median 15 days) prior to CABG. Endpoints were cardiovascular death (CVD) and all-cause mortality. We assessed amplitude of ESL (%), defined as peak positive strain, and duration of ESL (ms), determined as time from Q-wave on the ECG to peak positive strain. We applied Cox models adjusted for clinical risk assessed as EuroSCORE II. RESULTS During median follow-up of 3.8 years [IQR 2.7-4.9 years], 45 (6%) experienced CVD and 80 (11%) died. In survival analyses adjusted for EuroSCORE II, each 1% increase in amplitude of ESL was associated with CVD (HR 1.35 [95%CI 1.09-1.68], P = 0.006) and all-cause mortality (HR 1.29 [95%CI 1.08-1.54], P = 0.004). Similar findings applied to duration of ESL (per 10ms increase) and CVD (HR 1.12 [95%CI 1.02-1.23], P = 0.016) and all-cause mortality (HR 1.09 [95%CI 1.01--1.17], P = 0.031). The prognostic value of ESL amplitude was modified by sex (P interaction < 0.05), such that the prognostic value was greater in women for both endpoints. When adding ESL duration to EuroSCORE II, the net reclassification index improved significantly for both CVD and all-cause mortality. CONCLUSIONS Assessment of ESL provides independent and incremental prognostic information in addition to the EuroSCORE II for CVD and all-cause mortality in CABG patients.
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Key Words
- A, late transmitral inflow velocity
- CABG, coronary artery bypass graft
- CK-MB, creatine kinase myocardial band
- Deformation
- E, early transmitral inflow velocity
- ESL, early systolic lengthening
- GLS, global longitudinal strain
- HR, hazard ratio
- IDI, integrated discrimination improvement
- IQR, interquartile range
- LV, left ventricular
- LVEF, left ventricular ejection fraction
- NRI, net reclassification index
- Prognosis
- Revascularization
- Systolic lengthening
- e’, early diastolic tissue velocity
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Affiliation(s)
- Philip Brainin
- Department of Cardiology, Federal University of Acre, Acre, Brazil
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Søren Lindberg
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Flemming J. Olsen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Sune Pedersen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Allan Iversen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Søren Galatius
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Denmark
| | - Thomas Fritz-Hansen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Denmark
- Department of Clinical Medicine, Aalborg University, Denmark
| | - Rasmus Møgelvang
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark
- Department of Clinical Research, Faculty of Health and Medical Sciences, Svendborg, University of Southern Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen
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40
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Haider A, Bengs S, Luu J, Osto E, Siller-Matula JM, Muka T, Gebhard C. Sex and gender in cardiovascular medicine: presentation and outcomes of acute coronary syndrome. Eur Heart J 2021; 41:1328-1336. [PMID: 31876924 DOI: 10.1093/eurheartj/ehz898] [Citation(s) in RCA: 156] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/01/2019] [Accepted: 12/02/2019] [Indexed: 12/14/2022] Open
Abstract
Although health disparities in women presenting with acute coronary syndrome (ACS) have received growing attention in recent years, clinical outcomes from ACS are still worse for women than for men. Women continue to experience higher patient and system delays and receive less aggressive invasive treatment and pharmacotherapies. Gender- and sex-specific variables that contribute to ACS vulnerability remain largely unknown. Notwithstanding the sex differences in baseline coronary anatomy and function, women and men are treated the same based on guidelines that were established from experimental and clinical trial data over-representing the male population. Importantly, younger women have a particularly unfavourable prognosis and a plethora of unanswered questions remains in this younger population. The present review summarizes contemporary evidence for gender and sex differences in vascular biology, clinical presentation, and outcomes of ACS. We further discuss potential mechanisms and non-traditional risk conditions modulating the course of disease in women and men, such as unrecognized psychosocial factors, sex-specific vascular and neural stress responses, and the potential impact of epigenetic modifications.
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Affiliation(s)
- Ahmed Haider
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - Judy Luu
- Division of Cardiology, Department of Internal Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg MB R3A, Manitoba, Canada
| | - Elena Osto
- Institute of Clinical Chemistry, University of Zurich and University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.,Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Jolanta M Siller-Matula
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.,Centre for Preclinical Research and Technology, Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Zwirki i Wigury 61, 02-091 Warsaw, Poland
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland.,Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
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41
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Desai S, Munshi A, Munshi D. Gender Bias in Cardiovascular Disease Prevention, Detection, and Management, with Specific Reference to Coronary Artery Disease. J Midlife Health 2021; 12:8-15. [PMID: 34188420 PMCID: PMC8189342 DOI: 10.4103/jmh.jmh_31_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/01/2021] [Accepted: 03/10/2021] [Indexed: 01/09/2023] Open
Abstract
Even though cardiovascular disease (CVD) kills more women than men each year and remains a leading cause of death in women, it is a common misconception that women are less likely to develop CVD. Considerable sex difference exists between men and women with regard to prevention, investigations, and management of CVD. Coronary artery disease (CAD) is a major contributor to CVD morbidity and mortality and hence is specifically addressed in this article. With an explosive increase in the incidence of conventional risk factors for coronary artery disease in India, there has been an alarming increase in women's coronary events as much as men. A false sense of gender-based protection by estrogen leads to less aggressive and late prevention or management strategies that contribute to women's CAD. Metabolic syndrome (MetS) is an important contributor to future development of CAD and is also an indicator for earlier interventions for prevention. Due to physical inactivity and central obesity, MetS is more prevalent in women, especially postmenopausal. With estrogen loss, menopause marks a critical cardiovascular biological transition, with a significantly increased CVD risk in women aged >55 years. Certain female-specific risk factors, such as history of polycystic ovarian syndrome, pregnancy-induced hypertension, and gestational diabetes, also seem to play an essential role in the development of CVD in later life. Certain vascular and biological factors, such as smaller coronary vessel size, higher prevalence of small vessel disease, and lesser development of collateral flow, also play an important role. This review article is an attempt to provide important information on gender differences in CVD with specific emphasis on CAD.
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Affiliation(s)
- Shailesh Desai
- Consulting Preventive Cardiologist, Above Star Bazaar, Satellite Road, Ahmedabad, India
| | - Atul Munshi
- Consulting Obstetrician and Gynecologist, Ahmedabad, India.,Ex- Prof. & HOD, OBGYN, GCS & NHL Medical College, Ahmedabad, Munshi Group of Hospitals 50, Pritamnagar Society, Ellisbridge, Ahmedabad, India
| | - Devangi Munshi
- Department of OBGYN, Ahmedabad Municipal Corporation MET Medical College, Ahmedabad, India
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42
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Gupta S, Lui B, Ma X, Walline M, Ivascu NS, White RS. Sex Differences in Outcomes After Coronary Artery Bypass Grafting. J Cardiothorac Vasc Anesth 2020; 34:3259-3266. [DOI: 10.1053/j.jvca.2020.04.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 01/23/2023]
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43
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Veen KM, Mokhles MM, Braun J, Versteegh MIM, Bogers AJJC, Takkenberg JJM. Male-female differences in characteristics and early outcomes of patients undergoing tricuspid valve surgery: a national cohort study in the Netherlands. Eur J Cardiothorac Surg 2020; 55:859-866. [PMID: 30517619 DOI: 10.1093/ejcts/ezy390] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/14/2018] [Accepted: 10/17/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aims to explore male-female differences in baseline and procedural characteristics, and outcomes of patients undergoing isolated or concomitant tricuspid valve (TV) surgery. METHODS All TV procedures registered between 2007 and 2016 in the database of the Netherlands Association for Cardio-Thoracic Surgery were analysed. Logistic regression analyses with interaction terms were used to determine whether sex was associated with hospital mortality. RESULTS Five thousand five hundred and eighty-two patients underwent TV surgery [isolated: N = 685 (49% male), TVrepair: N = 5286 (50% male) and TVreplacement: N = 250 (46% male)]. In the TVrepair group, females were significantly older, had less prior percutaneous/surgical coronary interventions, less extracardiac arteriopathies, a lower prevalence of renal impairment, less endocarditis, a lower prevalence of preoperative critical condition, less recent myocardial infarction, less concomitant coronary artery bypass grafting (CABG) and, in case of concomitant mitral valve surgery, less concomitant mitral valve repair compared to males. In the TVreplacement group, females more often had a history of prior valve surgery and less prior CABG. Hospital mortality for males and females was 7.0% (N = 183) and 6.1% (N = 163), P = 0.241 in the TVrepair group and 2.6% (N = 3) and 8.8% (N = 12), P = 0.074 in the TVreplacement group. Sex was not associated with hospital mortality (odds ratio (OR) 1.14, 95% confidence interval (CI) 0.88-1.48; P = 0.322). Sex demonstrated a significant interaction with the parameter 'critical preoperative condition' (OR 0.44, 95% CI 0.22-0.90; P = 0.026). CONCLUSIONS Substantial differences in patient and procedural characteristics existed between male and female patients undergoing TV surgery, although sex was not a derterminant for hospital mortality. Nevertheless, sex interacted with a critical preoperative condition, indicating the usefulness of separate risk factor models for males and females requiring TV surgery.
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Affiliation(s)
- Kevin M Veen
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, Netherlands
| | - Mostafa M Mokhles
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, Netherlands
| | - Jerry Braun
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Michel I M Versteegh
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, Netherlands
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44
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Mahowald MK, Alqahtani F, Alkhouli M. Comparison of Outcomes of Coronary Revascularization for Acute Myocardial Infarction in Men Versus Women. Am J Cardiol 2020; 132:1-7. [PMID: 32773227 DOI: 10.1016/j.amjcard.2020.07.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 11/25/2022]
Abstract
This study sought to examine the differences in the characteristics and outcomes between men and women who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for acute myocardial infarction (AMI) in contemporary US practice. The Nationwide Inpatient Sample was used to identify patients who underwent revascularization for AMI between January 1, 2003 and December 31, 2016. The primary outcome was in-hospital mortality. Propensity score matching was utilized to account for differences in baseline characteristics. In total, 3,603,142 patients were included, of whom only 1,180,436 (33%) were women. Compared with men, women were older and had higher prevalence of key co-morbidities including diabetes, hypertension, congestive heart failure, and chronic kidney and lung disease (p <0.001). In the PCI cohort, women were significantly less likely to undergo multivessel PCI, to receive mechanical circulatory support, or to undergo atherectomy. In the CABG group, women were more likely to have concomitant valve surgery. In the propensity-matched cohorts, in-hospital mortality was higher for women than men regardless of revascularization strategy: 7.6% versus 6.6% for PCI in ST-elevation myocardial infarction, 2.0% versus 1.9% for PCI in non-ST-elevation myocardial infarction, and 5.7% versus 4.3% for CABG in any AMI (p <0.001). Women also had higher rates of major complications, longer hospitalizations, higher costs, and were less likely to be discharged home (vs nursing facility). These sex-based differences persisted over the study 14-year period. In conclusion, in a contemporary nationwide analysis of propensity score-matched patients, women who undergo revascularization for AMI have worse in-hospital outcomes than men regardless of revascularization mode.
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45
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Eicosanoid production varies by sex in mesenteric ischemia reperfusion injury. Clin Immunol 2020; 220:108596. [PMID: 32961332 DOI: 10.1016/j.clim.2020.108596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/13/2020] [Accepted: 09/16/2020] [Indexed: 01/18/2023]
Abstract
Intestinal ischemia/reperfusion (I/R)-induced injury is an inflammatory response with significant morbidity and mortality. The early inflammatory response includes neutrophil infiltration. However, the majority of rodent studies utilize male mice despite a sexual dimorphism in intestinal I/R-related diseases. We hypothesized that sex may alter inflammation by changing neutrophil infiltration and eicosanoid production. To test this hypothesis, male and female C57Bl/6 mice were subjected to sham treatment or 30 min intestinal ischemia followed by a time course of reperfusion. We demonstrate that compared to male mice, females sustain significantly less intestinal I/R-induced tissue damage and produced significant LTB4 concentrations. Male mice release PGE2. Finally, treatment with a COX-2 specific inhibitor, NS-398, attenuated I/R-induced injury, total peroxidase level, and PGE2 production in males, but not in similarly treated female mice. Thus, I/R-induced eicosanoid production and neutrophil infiltration varies between sexes suggesting that distinct therapeutic intervention may be needed in clinical ischemic diseases.
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46
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Gurram A, Krishna N, Vasudevan A, Baquero LA, Jayant A, Varma PK. Female Gender is not a Risk Factor for Early Mortality after Coronary Artery Bypass Grafting. Ann Card Anaesth 2020; 22:187-193. [PMID: 30971601 PMCID: PMC6489402 DOI: 10.4103/aca.aca_27_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The female gender is considered as a risk factor for morbidity and mortality after coronary artery bypass grafting (CABG). Aim: In this analysis, we assessed the impact of female gender on early outcome after CABG. Study Design: This is a retrospective analysis of data from our center situated in South India. Statistical Analysis: Patients were categorized according to gender and potential differences in pre-operative and post-operative factors were explored. Significant risk factors were then built in a multivariate model to account for differences in predicting gender influence on surgical outcome. Methods: 773 consecutive patients underwent first time CABG between January 2015 and December 2016. 96.77% of cases were performed using off-pump technique. 132 (17.07%) patients were females. These patients formed the study group. Results: The in-house/ 30-day mortality in females was similar to that of males (3.03% vs. 3.12%, p value 0.957). Mediastinitis developed more commonly in females (5.35% vs. 1.30%; p value 0.004) compared to males. There were more re-admissions to hospital for female patients (21.37% in females vs. 10.14% in males, p value <0.001). In multivariate analysis using logistic regression; there was a significant association between age (OR 1.08), chronic obstructive airway disease (OR 4.315), and use of therapeutic antibiotics (OR 6.299), IABP usage (OR 11.18) and renal failure requiring dialysis (OR 28.939) with mortality. Conclusions: Early mortality in females was similar to that of males. Females were associated with higher rate of wound infection and readmission to hospital.
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Affiliation(s)
- Akhil Gurram
- Divisions of Cardio-Thoracic Surgery, Amrita Institute of Medical Sciences and Research Center, Amrita Viswa Vidyapeetham (Amrita University), Kochi, Kerala, India
| | - Neethu Krishna
- Divisions of Cardio-Thoracic Surgery, Amrita Institute of Medical Sciences and Research Center, Amrita Viswa Vidyapeetham (Amrita University), Kochi, Kerala, India
| | - Anu Vasudevan
- Biostatistics, Amrita Institute of Medical Sciences and Research Center, Amrita Viswa Vidyapeetham (Amrita University), Kochi, Kerala, India
| | | | - Aveek Jayant
- Anesthesiology, Amrita Institute of Medical Sciences and Research Center, Amrita Viswa Vidyapeetham (Amrita University), Kochi, Kerala, India
| | - Praveen Kerala Varma
- Divisions of Cardio-Thoracic Surgery, Amrita Institute of Medical Sciences and Research Center, Amrita Viswa Vidyapeetham (Amrita University), Kochi, Kerala, India
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Sex-Specific Effects of the Nlrp3 Inflammasome on Atherogenesis in LDL Receptor-Deficient Mice. JACC Basic Transl Sci 2020; 5:582-598. [PMID: 32613145 PMCID: PMC7315187 DOI: 10.1016/j.jacbts.2020.03.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/11/2020] [Accepted: 03/11/2020] [Indexed: 12/27/2022]
Abstract
In this study we observed sex-specific effects of the NLRP3 inflammasome on atherogenesis in LDLR-deficient mice, with NLRP3 inflammasome playing a more prominent role in atherosclerosis in female mice than in males. Sex hormones may be involved in NLRP3 inflammasome–mediated atherogenesis and may underlie differential responses to anti-NLRP3 therapy between males and females. Testosterone may play an inhibitory role by blocking NLRP3 inflammasome and inflammation in atherogenesis, whereas female sex hormones may promote NLRP3 inflammasome–mediated atherosclerosis. The results of the present study may help design future clinical trials, with the objective to personalize cardiovascular care for men and women.
In the Ldlr-/- mouse model of atherosclerosis, female Nlrp3-/- bone marrow chimera and Nlrp3-/- mice developed significantly smaller lesions in the aortic sinus and decreased lipid content in aorta en face, but a similar protection was not observed in males. Ovariectomized female mice lost protection from atherosclerosis in the setting of NLRP3 deficiency, whereas atherosclerosis showed a greater dependency on NLRP3 in castrated males. Thus, castration increased the dependency of atherosclerosis on the NLRP3 inflammasome, suggesting that testosterone may block inflammation in atherogenesis. Conversely, ovariectomy reduced the dependency on NLRP3 inflammasome components for atherogenesis, suggesting that estrogen may promote inflammasome-mediated atherosclerosis.
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48
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Filardo G, Ailawadi G, Pollock BD, da Graca B, Phan TK, Thourani V, Damiano RJ. Postoperative atrial fibrillation: Sex-specific characteristics and effect on survival. J Thorac Cardiovasc Surg 2020; 159:1419-1425.e1. [DOI: 10.1016/j.jtcvs.2019.04.097] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 04/25/2019] [Accepted: 04/28/2019] [Indexed: 11/28/2022]
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49
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Bechtel AJ, Huffmyer JL. Gender Differences in Postoperative Outcomes After Cardiac Surgery. Anesthesiol Clin 2020; 38:403-415. [PMID: 32336392 DOI: 10.1016/j.anclin.2020.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Women presenting for cardiac surgery tend to be older and have hypertension, diabetes, and overweight or underweight body mass index than men. Despite improvements in surgical techniques and medications, women have increased risk for morbidity and mortality after multiple types of cardiac surgery. Women presenting for transcatheter aortic valve replacement are older and frailer than men, and have increased risk of intraoperative complications, but lower mortality at mid- and long-term ranges compared with men. Adherence to recovery and rehabilitation from cardiac surgery is challenging for women. Solutions should focus on increased family support, and use of group exercise and activities.
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Affiliation(s)
- Allison J Bechtel
- Department of Anesthesiology, University of Virginia Health, PO Box 800710, Charlottesville, VA 22908-0710, USA
| | - Julie L Huffmyer
- Department of Anesthesiology, University of Virginia Health, PO Box 800710, Charlottesville, VA 22908-0710, USA.
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50
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Huckaby LV, Seese LM, Sultan I, Gleason TG, Wang Y, Thoma F, Kilic A. The Impact of Sex on Outcomes After Revascularization for Multivessel Coronary Disease. Ann Thorac Surg 2020; 110:1243-1250. [PMID: 32199825 DOI: 10.1016/j.athoracsur.2020.02.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 12/21/2019] [Accepted: 02/06/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Coronary artery disease has historically been responsible for more deaths among women than men, and previous studies have suggested sex differences in revascularization approaches and outcomes. We sought to compare sex-specific adverse events in patients who underwent percutaneous or surgical revascularization for multivessel coronary artery disease. METHODS All patients at a single institution undergoing percutaneous coronary intervention or coronary artery bypass graft surgery for multivessel coronary artery disease between 2011 and 2018 were included. Propensity score matching was utilized to compare patients with similar baseline characteristics. Outcomes included death, major adverse cardiac and cerebrovascular events (MACCE), repeat revascularization, and readmissions. RESULTS Of the 6163 patients, 1679 (27.2%) were female. Male patients were more likely to have three-vessel disease (71.9% vs 68.6%, P = .002) and to undergo complete revascularization (69.9% vs 66.4%, P = .008). Female sex was associated with an increased hazard for death (hazard ratio 1.16, P = .03) and MACCE (hazard ratio 1.16, P = .02) but not repeat revascularization (hazard ratio 1.23, P = .16). In the matched cohorts, female sex was associated with lower survival at 1 year (90.63% vs 93.12%, P = .01) but not at 5 years (76.64% vs 77.33%, P = .20). Similarly, freedom from MACCE was lower for female patients at 1 year (87.79% vs 90.19%, P = .03) but was comparable at 5 years (73.22% vs 74.3%, P = .10). CONCLUSIONS In a matched analysis pooling percutaneous and surgical revascularization, female sex was associated with worse outcomes at 1 year although there were no sex differences at 5 years of follow-up. Increasing coronary artery bypass graft surgery utilization and the completeness of revascularization in female patients may be targets for improving 1-year survival and freedom from MACCE.
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Affiliation(s)
- Lauren V Huckaby
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Laura M Seese
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ibrahim Sultan
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Thomas G Gleason
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Yisi Wang
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Floyd Thoma
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Arman Kilic
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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