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

Abstract

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 meanwhile registry data and trial sub-analyses provide controversial results. We systematically assessed the survival after CABG in both sexes by analyzing studies that assessed CABG outcomes compared to 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. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated.

Results: A total of 1,352 studies were retrieved. Eight studies and 142,165 patients were included in the analysis. For the entire 19-year 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). Performing landmark analyses suggests that there is no difference in life expectancy compared with the general population in the first 10 years. The direct comparison of men versus women suggests that very long-term survival was slightly better in women (HR: 1.04, 95% CI, 1.01-1.08).

Conclusions: Both men and women after CABG treatment for CAD experience similar life expectancy in the first decade compared to 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.