Coronary Artery Bypass Grafting in Women 50 Years or Younger

Magnus Dalén, Susanne Nielsen, Torbjörn Ivert, Martin J Holzmann, Ulrik Sartipy, Magnus Dalén, Susanne Nielsen, Torbjörn Ivert, Martin J Holzmann, Ulrik Sartipy

Abstract

Background Prior research has shown higher mortality in women with severe coronary artery disease compared with men, particularly in younger patients. It is unknown if this could be attributable to an adverse risk factor profile. Methods and Results In a population-based cohort study, we included all adults ≤50 years of age (932 women and 4514 men) who underwent coronary artery bypass grafting from 1995 to 2013 from the SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) register. Following inverse probability of treatment weighting, we investigated differences between women and men. Women had a higher prevalence of cardiovascular risk factors compared with men. There was no difference in early mortality between women and men (unadjusted: 1.3% versus 0.9%; hazard ratio, 1.42; 95% CI, 0.75-2.70; weighted sample: 1.1% versus 1.0%; hazard ratio, 1.10; 95% CI, 0.52-2.30). During a median follow-up time of 11.8 years, in the unweighted population, the risk of death was greater in women compared with men (hazard ratio, 1.34; 95% CI, 1.13-1.58). However, in the weighted sample, the risk of death was not significantly different in women compared with men (hazard ratio, 1.02; 95% CI, 0.83-1.26). Conclusions Women ≤50 years of age had a higher unadjusted risk of death after coronary artery bypass grafting compared with men, but this was explained by a clustering of cardiovascular risk factors. Female sex per se was not associated with increased mortality or major adverse cardiovascular events. Early mortality was not increased in women compared with men, even though younger women in our study had an increased burden of risk factors known to affect early risk. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02276950.

Keywords: coronary artery bypass graft surgery; coronary artery disease; outcome; women.

Figures

Figure 1
Figure 1
Survival is plotted against time after surgery and stratified according to sex. The upper panel shows the unweighted study population, and the lower panel shows the weighted sample. Male patients are the reference group. The numbers of patients at risk are not necessarily integers in the lower panel because of inverse probability of treatment weighting. HR indicates hazard ratio; IPTW, inverse probability of treatment weighting.
Figure 2
Figure 2
Selected patient characteristics associated with all‐cause mortality. Hazard ratios are adjusted for all variables presented in Table. COPD indicates chronic obstructive pulmonary disease; eGFR, estimated glomerular filtration rate; ESRD, end‐stage renal disease; LVEF, left ventricular ejection fraction.
Figure 3
Figure 3
Clinical outcomes are plotted against time after surgery and stratified according to sex. The left‐hand panel shows the unweighted study population, and the right‐hand panel shows the weighted sample. Male patients are the reference group. Repeat revascularization refers to a new coronary intervention (PCI/CABG) following the index CABG. The numbers of patients at risk are not necessarily integers because of inverse probability of treatment weighting (right‐hand panel). CABG indicates coronary artery bypass grafting; HR, hazard ratio; IPTW, inverse probability of treatment weighting; PCI, percutaneous coronary intervention.

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