Comparison of 3-Year Outcomes for Coronary Artery Bypass Graft Surgery and Drug-Eluting Stents: Does Sex Matter?

Edward L. Hannan, Ye Zhong, Chuntao Wu, Alice K. Jacobs, Nicholas J. Stamato, Samin Sharma, Jeffrey P Gold, Andrew S. Wechsler

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background Several randomized controlled trials and observational studies have compared outcomes for coronary artery bypass graft (CABG) surgery and drug-eluting stents (DES), but these studies have not thoroughly investigated the relative difference in outcomes by sex. We aimed to compare 3-year outcomes (mortality, mortality/myocardial infarction/stroke, and repeat revascularization) for CABG surgery and percutaneous coronary interventions with DES by sex. Methods A total of 4,532 women (2,266 pairs of CABG and DES patients) and 11,768 men (5,884 pairs) were propensity matched separately using multiple patient risk factors and were compared with respect to 3-year outcomes. Results Both women and men receiving DES had significantly higher mortality rates (adjusted hazard ratio, 1.28; 95% confidence interval, 1.06 to 1.54 and adjusted hazard ratio, 1.22; 95% confidence interval, 1.06 to 1.41, respectively) and myocardial infarction/mortality/stroke rates (adjusted hazard ratio, 1.40; 95% confidence interval, 1.19 to 1.64 and adjusted hazard ratio, 1.36; 95% confidence interval, 1.20 to 1.54, respectively) with DES. The advantage for CABG surgery was also present for several preselected patient subgroups. Men had consistently lower adverse outcome rates than women for both procedures. For example, the mortality rates for CABG and DES for men were 8.0% and 9.1%, compared with respective rates of 11.8% and 13.7% for women. Conclusions For women, the advantage of CABG surgery over DES is very similar to what was found for men, and this advantage persisted for patients with and without high-risk characteristics.

Original languageEnglish (US)
Pages (from-to)2227-2236
Number of pages10
JournalAnnals of Thoracic Surgery
Volume100
Issue number6
DOIs
StatePublished - Jan 1 2015

Fingerprint

Drug-Eluting Stents
Coronary Artery Bypass
Transplants
Mortality
Confidence Intervals
Stroke
Myocardial Infarction
Percutaneous Coronary Intervention
Randomized Controlled Trials

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Hannan, E. L., Zhong, Y., Wu, C., Jacobs, A. K., Stamato, N. J., Sharma, S., ... Wechsler, A. S. (2015). Comparison of 3-Year Outcomes for Coronary Artery Bypass Graft Surgery and Drug-Eluting Stents: Does Sex Matter? Annals of Thoracic Surgery, 100(6), 2227-2236. https://doi.org/10.1016/j.athoracsur.2015.05.103

Comparison of 3-Year Outcomes for Coronary Artery Bypass Graft Surgery and Drug-Eluting Stents : Does Sex Matter? / Hannan, Edward L.; Zhong, Ye; Wu, Chuntao; Jacobs, Alice K.; Stamato, Nicholas J.; Sharma, Samin; Gold, Jeffrey P; Wechsler, Andrew S.

In: Annals of Thoracic Surgery, Vol. 100, No. 6, 01.01.2015, p. 2227-2236.

Research output: Contribution to journalArticle

Hannan, Edward L. ; Zhong, Ye ; Wu, Chuntao ; Jacobs, Alice K. ; Stamato, Nicholas J. ; Sharma, Samin ; Gold, Jeffrey P ; Wechsler, Andrew S. / Comparison of 3-Year Outcomes for Coronary Artery Bypass Graft Surgery and Drug-Eluting Stents : Does Sex Matter?. In: Annals of Thoracic Surgery. 2015 ; Vol. 100, No. 6. pp. 2227-2236.
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abstract = "Background Several randomized controlled trials and observational studies have compared outcomes for coronary artery bypass graft (CABG) surgery and drug-eluting stents (DES), but these studies have not thoroughly investigated the relative difference in outcomes by sex. We aimed to compare 3-year outcomes (mortality, mortality/myocardial infarction/stroke, and repeat revascularization) for CABG surgery and percutaneous coronary interventions with DES by sex. Methods A total of 4,532 women (2,266 pairs of CABG and DES patients) and 11,768 men (5,884 pairs) were propensity matched separately using multiple patient risk factors and were compared with respect to 3-year outcomes. Results Both women and men receiving DES had significantly higher mortality rates (adjusted hazard ratio, 1.28; 95{\%} confidence interval, 1.06 to 1.54 and adjusted hazard ratio, 1.22; 95{\%} confidence interval, 1.06 to 1.41, respectively) and myocardial infarction/mortality/stroke rates (adjusted hazard ratio, 1.40; 95{\%} confidence interval, 1.19 to 1.64 and adjusted hazard ratio, 1.36; 95{\%} confidence interval, 1.20 to 1.54, respectively) with DES. The advantage for CABG surgery was also present for several preselected patient subgroups. Men had consistently lower adverse outcome rates than women for both procedures. For example, the mortality rates for CABG and DES for men were 8.0{\%} and 9.1{\%}, compared with respective rates of 11.8{\%} and 13.7{\%} for women. Conclusions For women, the advantage of CABG surgery over DES is very similar to what was found for men, and this advantage persisted for patients with and without high-risk characteristics.",
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AU - Jacobs, Alice K.

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