Survival Trends of Patients after Coronary Artery Bypass Grafting and Sex-specific Differences—A Meta-analysis of Reconstructed Time-to-event Data

Background: Randomized evidence suggest that coronary artery bypass grafting (CABG) has the potential to improve life expectancy. Women are considered to have worse outcomes after CABG, but they are generally underrepresented in randomized trials. Registry data and trial sub-analyses provide controversial results for CABG in women. We systematically assessed the survival-improving potential of CABG in both sexes by analyzing studies that assessed CABG outcomes compared with the age-matched general population.

Methods: Three databases were assessed (MEDLINE, ScienceDirect, and Cochrane Library). Primary and single outcome was long-term all-cause mortality. Reconstruction of time-to-event data was performed. Sex-specific data from the arms were separately extracted. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated. Landmark analysis was performed to check the robustness of the estimated effect.

Results: A total of 1,352 studies were retrieved. Eight studies encompassing 142,165 patients were included in the analysis. For the entire 19 years observation period, patients who underwent CABG had worse survival than the general population in both male (HR = 1.14, 95% CI, 1.05–1.23, p = 0.002) and female patients (HR = 1.21, 95% CI, 1.01–1.47, p = 0.045). However, the curves separated only after approximately 10 years which coincided with a violation of the proportional of hazard ratio assumption of the analysis. Performing landmark analyses suggest that there is no difference in life expectancy compared with the general population in the first decade. The direct comparison of men versus women suggests that very long-term survival was slight better in women (HR: 1.04, 95% CI, 1.01–1.08).

Conclusion: Both men and women after CABG for treatment of CAD experience similar life expectancy in the first decade compared with the general population. Beyond 10 years, life expectancy becomes worse than the general population and is the worst in men. It may be speculated that this difference is due to graft occlusions.

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Artikel online veröffentlicht:
11. Februar 2025