SPC365

The impact of sex on long-term survival after coronary artery bypass grafting: 19-years of follow-up

Session: Sessão de Posters 25 - Cirurgia cardíaca
Speaker: Inês Sousa

Congress: CPC 2024
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 26. Cardiovascular Surgery
Subtheme: 26.11 Cardiovascular Surgery - Other
Session Type: Cartazes
FP Number: ---
Authors: Inês Sousa; Sílvia O. Dias; Rui Cerqueira; Ana Filipa Ferreira; Mário J. Amorim; Paulo Pinho; André P. Lourenço; António S. Barros; Francisca Saraiva; Adelino Leite- Moreira

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Introduction</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: Patient&acute;s sex has been studied as a determining element in the prognosis after CABG but results are conflicting and focused on the first 5-years of follow-up.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Aim</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: To evaluate the impact of sex on long-term survival after CABG, according to age subgroups and compare immediate post-operative outcomes.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Methods</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: Longitudinal, retrospective, single-center study including consecutive patients who underwent primary isolated CABG between 2004-2014. Exclusion criteria: emergent or salvage surgeries or use of on-pump beating-heart. The included patients were divided in subgroups of age: &le;60, 60-70 and &ge;70 years old. The primary outcome was all-causes mortality (February 2023). Time-to-event outcomes were studied using Kaplan-Meier Curves, Log-Rank test, multivariable Cox Regression and time-split analysis. Median follow-up was 11 years, maximum of 19 years.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Results</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: From 3977 patients who underwent primary isolated CABG the percentage of women (W) in each subgroup of age varied between 13% and 27. They were older (mean age 66&plusmn;9 vs 63&plusmn;9 years, p&lt;0.001), had higher prevalence of arterial hypertension, diabetes mellitus, obesity and severe chronic kidney disease than men (M). M had more often peripheral artery disease, smoking habits and chronic obstrutive pulmonary disease. Although the prevalence of 3-vessels disease was similar between W and M (p=0.112), the median number of grafts was higher in M (2.67&plusmn;0.89 vs 2.49&plusmn;0.89, p&lt;0.001), probably at the expense of more bilateral internal mammary artery utilization (36% vs 24% p&lt;0.001). Of note, completeness of revascularization was similar between groups (55% vs 55%, p=0.93). At 5-, 10- and 15- years of follow-up, cumulative survival for M vs W were 89% vs 88%, 73% vs 67%, 56% vs 46%, respectively, Log Rank test p&lt;0.001. After stratifying by age subgroups, Log-Rank tests did not show differences between sexes (&lt;60: p=0.29; 60-70: p=0.51; &gt;70: p=0.65). Multivariable adjustment showed that patient&rsquo;s sex was not associated with long-term survival, irrespective of age subgroup (HR [95%CI] within &le;60: 1.28 [0.87-1.87], p=0.2; 60-70: 1.12 [0.88-1.41], p=0.4; &ge;70:1.01 [0.86-1.20], p=0.9). </span></span><span style="font-family:&quot;Times New Roman&quot;,serif">However, a time-split analysis, performed due to non-proportional hazards of sex in the subgroup &ge;70 years, showed that M present lower risk than W after 10 years of follow-up (HR: 0.70 [0.50-0.98], p=0.038).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusion</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: </span></span><span style="font-family:&quot;Times New Roman&quot;,serif">In this study, men older than 70 years undergoing isolated CABG evidenced better survival than women of the same age, in the longest follow-up period, i.e. only 10-years after surgery. </span><span style="font-family:&quot;Times New Roman&quot;,serif">No significant differences were evidenced within the other age subgroups.</span></span></span></p>