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Matthews S, Buttery A, O'Neil A, Sanders J, Marasco S, Fredericks S, Martorella G, Keenan N, Ghanes A, Wynne R. Sex differences in mortality after first time, isolated coronary artery bypass graft surgery: a systematic review and meta-analysis of randomized controlled trials. Eur J Cardiovasc Nurs 2022; 21:759-771. [PMID: 35553670 DOI: 10.1093/eurjcn/zvac028] [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: 08/17/2021] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 12/29/2022]
Abstract
AIM Reports of sex-specific differences in mortality after coronary artery bypass graft surgery (CABGS) are contradictory. The review aim was to determine whether CABGS is differentially efficacious than alternative procedures by sex, on short- and longer-term mortality. METHODS AND RESULTS EMBASE, CINAHL, Medline, and the Cochrane Library were searched. Inclusion criteria: English language, randomized controlled trials from 2010, comparing isolated CABGS to alternative revascularization. Analyses were included Mantel-Haenszel fixed-effects modelling, risk of bias (Cochrane RoB2), and quality assessment (CONSORT). PROSPERO Registration ID: CRD42020181673. The search yielded 4459 citations, and full-text review of 29 articles revealed nine studies for inclusion with variable time to follow-up. Risk of mortality for women was similar in pooled analyses [risk ratio (RR) 0.94, 95% confidence interval (CI) 0.84-1.05, P = 0.26] but higher in sensitivity analyses excluding 'high risk' patients (RR 1.22, 95% CI 1.01-1.48, P = 0.04). At 30 days and 10 years, in contrast to men, women had an 18% (RR 0.82, 95% CI 0.66-1.02, P = 0.08) and 19% (RR 0.81, 95% CI 0.69-0.95, P = 0.01) mortality risk reduction. At 1-2 years women had a 7% (RR 1.07, 95% CI 0.69-1.64, P = 0.77), and at 2-5 years a 25% increase in risk of mortality compared with men (RR 1.25, 95% CI 1.03-1.53, P = 0.03). Women were increasingly under-represented over time comprising 41% (30 days) to 16.7% (10 years) of the pooled population. CONCLUSION Meta-analysis revealed inconsistent sex-specific differences in mortality after CABGS. Trials with sex-specific stratification are required to ensure appropriate sex-differentiated treatments for revascularization.
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Affiliation(s)
- Stacey Matthews
- National Heart Foundation of Australia, Melbourne, VIC, Australia
- Melbourne School of Population & Global Health, University of Melbourne, Parkville, VIC, Australia
- Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Amanda Buttery
- National Heart Foundation of Australia, Melbourne, VIC, Australia
| | - Adrienne O'Neil
- Melbourne School of Population & Global Health, University of Melbourne, Parkville, VIC, Australia
- Food and Mood Centre, School of Medicine, Barwon Health, Deakin University, iMPACT (the Institute for Mental and Physical Health and Clinical Translation), Geelong, VIC, Australia
| | - Julie Sanders
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- William Harvey Research Institute, Charterhouse Square Barts, London, UK
- London School of Medicine and Dentistry Queen Mary University of London, London EC1 M 6BQ, UK
| | - Silvana Marasco
- Department of Surgery, The Alfred Hospital, Melbourne, VIC, Australia
- Department of Surgery, Monash University, Melbourne, VIC, Australia
| | - Suzanne Fredericks
- Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria St, Toronto m5B 2K3, Canada
| | - Geraldine Martorella
- Tallahassee Memorial Healthcare Center for Research and Evidence-Based Practice, Florida State University, 98 Varsity Way, Tallahassee, FL 32304, USA
| | | | | | - Rochelle Wynne
- Royal Melbourne Hospital, Parkville, VIC, Australia
- School of Nursing and Midwifery, Deakin University, Gheringhap Street, Geelong, VIC 3220, Australia
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Cook S, Matthews S, Murray S, Bueser T, Wynne R, Clayton T, Sanders J. Wonder women: wondering where the women in cardiovascular trials are? Eur J Cardiovasc Nurs 2021; 20:629-630. [PMID: 34431995 DOI: 10.1093/eurjcn/zvab074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 08/16/2021] [Indexed: 11/14/2022]
Affiliation(s)
- Samantha Cook
- St Bartholomew's Hospital, Barts Health NHS Trust, London EC1A 7BE, UK
| | - Stacey Matthews
- Heart Foundation, Level 2 850 Collins Street, Docklands, VIC 3008, Australia
| | - Sarah Murray
- Lay Representative Group, Society of Cardiothoracic Society of Great Britain and Ireland, 35-43 Lincoln's Inn Fields, London WC2A 3PE, UK
| | - Teofila Bueser
- St Bartholomew's Hospital, Barts Health NHS Trust, London EC1A 7BE, UK
| | - Rochelle Wynne
- Western Sydney Nursing & Midwifery Research Centre, Research & Education Network WSLHD and Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Tim Clayton
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Julie Sanders
- St Bartholomew's Hospital, Barts Health NHS Trust, London EC1A 7BE, UK.,William Harvey Research Institute, Queen Mary University of London, London EC1M 6BQ, UK
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