Sex is suggested to influence outcomes after coronary artery bypass grafting (CABG) although evidence on long-term mortality is controversial and cardiovascular outcome data is lacking. We studied sex differences in outcomes after isolated CABG.
Consecutive patients with first-time isolated CABG for stable coronary artery disease between 2004-2014 in Finland were retrospectively recognized from national registry (n=14681, 21% women). Propensity scoring and inverse probability weighting were used to adjust for baseline features. Median follow-up was 10.0 (max 14.6) years.
Cumulative major adverse cardiovascular event (MACE; myocardial infarction, stroke, or cardiovascular death) rate was 44.5% in men and 49.9% in women during the follow-up (Hazard ratio [HR] 0.98; p=0.633). All-cause mortality was 48.5 % in men vs. 46.0% in women (HR 1.20; CI 1.11-1.30; p<0.0001) and cardiovascular mortality 29.5% vs. 31.3% (p=0.625). Stroke rate was comparable between men and women (19.4% vs. 23.6%; p=0.625). Myocardial infarction occurred more frequently in women (20.0% vs. 23.6%; HR 0.84; CI 0.75-0.95; p=0.005). Redo revascularization was performed to 12.8% of women and 12.6% of men (p=0.100). Anticoagulation was more frequently used by men and adenosine diphosphate-inhibitors and diuretics by women after CABG. Usage of statins, angiotensin-converting-enzyme-inhibitors/angiotensin-blockers, beta-blockers, ca-blockers, or nitrates did not differ between sexes after CABG.
Sex was not an independent predictor of long-term MACE after CABG in this population-based cohort study. Men had however higher long-term all-cause mortality and women higher risk of myocardial infarction. Long-term outcomes should be accounted for when considering sex as a risk factor for CABG.