Coronary Artery Bypass Graft Failure in Women: Incidence and Clinical Implications. (2024)

Afiliação

• Sandner S; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA; Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
• Redfors B; Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Gothenburg University, Gothenburg, Sweden.
• An KR; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA; Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada.
• Harik L; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA.
• Heise R; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA.
• Di Franco A; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA.
• Fremes SE; Schulich Heart Centre Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
• Hare DL; Department of Cardiology, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.
• Kulik A; Division of Cardiac Surgery, Boca Raton Regional Hospital and Florida Atlantic Hospital, Boca Raton, Florida, USA.
• Lamy A; Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
• Peper J; Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands.
• Ruel M; Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
• Ten Berg JM; Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands.
• Willemsen LM; Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands.
• Zhao Q; Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
• Zhu Y; Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
• Wojdyla DM; Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
• Bhatt DL; Mount Sinai Heart, Icahn School of Medicine, Mount Sinai, New York, New York, USA.
• Alexander JH; Department of Medicine and Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
• Gaudino M; Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA. Electronic address: mfg9004@med.cornell.edu.

ABSTRACT

BACKGROUND:

Women have worse outcomes after coronary artery bypass surgery (CABG) than men.

OBJECTIVES:

This study aimed to determine the incidence of CABG graft failure in women, its association with cardiac events, and whether it contributes to sex-related differences in outcomes.

METHODS:

A pooled analysis of individual patient data from randomized clinical trials with systematic imaging follow-up was performed. Multivariable logistic regression models were used to assess the association of graft failure with myocardial infarction and repeat revascularization between CABG and imaging (primary outcome) and death after imaging (secondary outcome). Mediation analysis was performed to evaluate the effect of graft failure on the association between female sex and risk of death.

RESULTS:

Seven randomized clinical trials (N = 4,413, 777 women) were included. At a median imaging follow-up of 1.03 years, graft failure was significantly more frequent among women than men (37.3% vs 32.9% at the patient-level and 20.5% vs 15.8% at the graft level; P = 0.02 and P<0.001, respectively). In women, graft failure was associated withan increased risk of myocardial infarction and repeat revascularization (OR 3.94; 95%CI 1.79-8.67) and death (OR3.18; 95%CI 1.73-5.85). Female sex was independently associated with the risk of death (direct effect, HR 1.84; 95%CI 1.35-2.50) but the association was not mediated by graft failure (indirect effect, HR 1.04; 95%CI 0.86-1.26).

CONCLUSIONS:

Graft failure is more frequent in women and is associated with adverse cardiac events. Theexcessmortality risk associated with female sex among CABG patients is not mediated by graft failure.