Does a similar procedure result in similar survival for women and men undergoing isolated coronary artery bypass grafting?  Tamer Attia, MD, MSc, Colleen.

Slides:



Advertisements
Similar presentations
Tomislav Mihaljevic, MD, Edward R
Advertisements

Spinal cord protective strategies during descending and thoracoabdominal aortic aneurysm repair in the modern era: The role of intrathecal papaverine 
Robert J. Dabal, MD, James K
Advising complex patients who require complex heart operations
Should lung transplantation be performed for patients on mechanical respiratory support? The US experience  David P. Mason, MD, Lucy Thuita, MS, Edward.
Siva Raja, MD, PhD, Thomas W. Rice, MD, John Ehrlinger, PhD, John R
Increased late mortality after coronary artery bypass surgery complicated by isolated new-onset atrial fibrillation: A comprehensive propensity-matched.
Lars G. Svensson, MD, PhD, Lillian H. Batizy, MS, Eugene H
Determinants of repair type, reintervention, and mortality in 393 children with double- outlet right ventricle  Timothy J. Bradley, MD, Tara Karamlou,
Effect of changes in postoperative spirometry on survival after lung transplantation  David P. Mason, MD, Jeevanantham Rajeswaran, MSc, Liang Li, PhD,
Endovascular versus open elephant trunk completion for extensive aortic disease  Eric E. Roselli, MD, Sreekumar Subramanian, MD, Zhiyuan Sun, BS, Jahanzaib.
The least of 3 evils: Exposure to red blood cell transfusion, anemia, or both?  Gabriel Loor, MD, Jeevanantham Rajeswaran, PhD, Liang Li, PhD, Joseph F.
Surgical treatment of pseudoaneurysm of the thoracic aorta
Joseph F. Sabik, MD, Bruce W. Lytle, MD, Eugene H
Factors influencing early and late outcome of the arterial switch operation for transposition of the great arteries  Gil Wernovsky, MD* (by invitation),
Mauro Lo Rito, MD, Tamadhir Gazzaz, MD, Travis J. Wilder, MD, Rachel D
Duration of inotropic support after left ventricular assist device implantation: Risk factors and impact on outcome  Soren Schenk, MD, Patrick M. McCarthy,
Reoperation After Mitral Valve Repair for Degenerative Disease
Bruce W. Lytle, MD, Eugene H. Blackstone, MD, Joseph F
Surgical revascularization techniques that minimize surgical risk and maximize late survival after coronary artery bypass grafting in patients with diabetes.
Clostridium difficile infection after cardiac surgery: Prevalence, morbidity, mortality, and resource utilization  Suresh Keshavamurthy, MBBS, MS, Colleen.
Coronary artery bypass grafting in diabetics: A growing health care cost crisis  Sajjad Raza, MD, Joseph F. Sabik, MD, Ponnuthurai Ainkaran, MS, Eugene.
Gender profiling in coronary artery bypass grafting
Surgical Repair of Posterior Mitral Valve Prolapse: Implications for Guidelines and Percutaneous Repair  Douglas R. Johnston, MD, A. Marc Gillinov, MD,
Surgical management of competing pulmonary blood flow affects survival before Fontan/Kreutzer completion in patients with tricuspid atresia type I  Travis.
Gabriel Loor, MD, Colleen G. Koch, MD, MS, MBA, Joseph F
Prosthesis size and long-term survival after aortic valve replacement
Appropriate patient selection or health care rationing
Spinal cord protective strategies during descending and thoracoabdominal aortic aneurysm repair in the modern era: The role of intrathecal papaverine 
Aortic valve replacement: Is valve size important?
Simple versus complex degenerative mitral valve disease
A. Marc Gillinov, MD, Eugene H. Blackstone, MD, Edward R
Does arterial revascularization decrease the risk of infarction after coronary artery bypass grafting?  Paul T Sergeant, MD, PhD, Eugene H Blackstone,
Gabriel Loor, MD, Liang Li, PhD, Joseph F
Atrial fibrillation complicating lung cancer resection
Long-Term Durability of Bicuspid Aortic Valve Repair
Reduced survival in women after valve surgery for aortic regurgitationEffect of aortic enlargement and late aortic rupture  Monica L. McDonald, MDa, Nicholas.
Outcomes of less invasive J-incision approach to aortic valve surgery
A time-related parametric risk factor analysis for postoperative atrial fibrillation after heart surgery  Spencer J. Melby, MD, James F. George, PhD,
Nicholas G. Smedira, MD, Katherine J. Hoercher, RN, Dustin Y
Sajjad Raza, MD, Joseph F. Sabik, MD, Stephen G. Ellis, MD, Penny L
Eugene H. Blackstone, MDa,b, Bruce W. Lytle, MDb 
Marta Kelava, MD, Michael Robich, MD, MSPH, Penny L
Distal aortic interventions after repair of ascending dissection: The argument for a more aggressive approach  Eric E. Roselli, MD, Gabriel Loor, MD,
A meta-analysis of adjusted hazard ratios from 20 observational studies of bilateral versus single internal thoracic artery coronary artery bypass grafting 
Sudish C. Murthy, MD, PhD, Edward R. Nowicki, MD, MS, David P
Two internal thoracic artery grafts are better than one
Impact of the second internal thoracic artery on short- and long-term outcomes in obese patients: A propensity score matched analysis  Umberto Benedetto,
Are allografts the biologic valve of choice for aortic valve replacement in nonelderly patients? Comparison of explantation for structural valve deterioration.
Long-term effectiveness of operations for ascending aortic dissections
Decision support in surgical management of ischemic cardiomyopathy
Isolated bypass grafting of the left internal thoracic artery to the left anterior descending coronary artery  Rosalyn Scott, MDa, Eugene H. Blackstone,
Mohammed A Quader, MD, Patrick M McCarthy, MD, A
Colleen G. Koch, MD, MS, MBA, Edward R
Late outcomes after radial artery versus saphenous vein grafting during reoperative coronary artery bypass surgery  Anoar Zacharias, MD, Thomas A. Schwann,
Ventilatory dependency after cardiovascular surgery
Joseph F. Sabik, MD, Gabriel Olivares, MD, Sajjad Raza, MD, Bruce W
Douglas R. Johnston, MD, Edward G
Turki B. Albacker, MD, MSc, Eugene H. Blackstone, MD, Sarah J
Mitral valve repair with aortic valve replacement is superior to double valve replacement  A.Marc Gillinov, MD, Eugene H Blackstone, MD, Delos M Cosgrove,
Siva Raja, MD, PhD, Jay J. Idrees, MD, Eugene H
Guidance for the use of bilateral internal thoracic arteries according to survival benefit across age groups  Umberto Benedetto, MD, PhD, Mohamed Amrani,
Arvind K. Agnihotri, MD (by invitation), David C
Off-pump bilateral skeletonized internal thoracic artery grafting in patients with chronic kidney disease  Takeshi Kinoshita, MD, PhD, Tohru Asai, MD,
Pulmonary hypertension is associated with worse early and late outcomes after aortic valve replacement: Implications for transcatheter aortic valve replacement 
A. Marc Gillinov, MD, Jon Sirak, MD, Eugene H
National trends in utilization and in-hospital outcomes of mechanical versus bioprosthetic aortic valve replacements  Abby J. Isaacs, MS, Jeffrey Shuhaiber,
Lung Transplantation for Idiopathic Pulmonary Fibrosis
Fernando A. Atik, MD, Lars G. Svensson, MD, PhD, FACC, Eugene H
Time-related mortality for women after coronary artery bypass graft surgery: a population-based study  Veena Guru, MD, Stephen E Fremes, MD, MSc, Jack.
Presentation transcript:

Does a similar procedure result in similar survival for women and men undergoing isolated coronary artery bypass grafting?  Tamer Attia, MD, MSc, Colleen G. Koch, MD, MS, MBA, Penny L. Houghtaling, MS, Eugene H. Blackstone, MD, Ellen Mayer Sabik, MD, Joseph F. Sabik, MD  The Journal of Thoracic and Cardiovascular Surgery  Volume 153, Issue 3, Pages 571-579.e9 (March 2017) DOI: 10.1016/j.jtcvs.2016.11.033 Copyright © 2016 Terms and Conditions

Figure 1 Survival after cardiac surgery in men and women. Symbols represent Kaplan-Meier estimates at 5-year intervals and vertical bars confidence limits equivalent to ±1 standard error. Solid curves are parametric survival estimates. Red lines and triangles represent women and blue lines and circles men. Dash-dot-dash lines are age-sex-race–matched survival estimates for the US population. Number of patients remaining at risk at 5-year intervals is shown beneath the horizontal axis. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 571-579.e9DOI: (10.1016/j.jtcvs.2016.11.033) Copyright © 2016 Terms and Conditions

Figure 2 Survival after coronary artery bypass grafting stratified by sex and completeness of revascularization. A, Unadjusted Kaplan-Meier estimates, with confidence limits equivalent to ±1 standard error shown as vertical bars at 5-year intervals. Number of patients remaining at risk at 5-year intervals is shown beneath horizontal axis. B, Adjusted. Nomogram for survival of a patient with typical female characteristics based on the multivariable model (Tables E2 and E3), with variables held constant, as noted in the Methods. Single internal thoracic artery grafting is simulated for both men and women. CR, Complete revascularization; IR, incomplete revascularization. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 571-579.e9DOI: (10.1016/j.jtcvs.2016.11.033) Copyright © 2016 Terms and Conditions

Figure 3 Forest plot of early and late survival after coronary artery bypass grafting according to revascularization strategy, adjusted for differences in characteristics between women and men. Symbols represent the hazard ratio and horizontal bars 95% confidence limits. Note difference in horizontal scales. CR, Complete revascularization; SITA, single internal thoracic artery grafting; BITA, bilateral internal thoracic artery grafting. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 571-579.e9DOI: (10.1016/j.jtcvs.2016.11.033) Copyright © 2016 Terms and Conditions

Figure 4 Survival after coronary artery bypass grafting stratified by sex and single versus bilateral internal thoracic artery grafting. BITA, Bilateral internal thoracic artery grafting; SITA, single internal thoracic artery grafting. A, Women. Format is as in Figure 2, A. B, Men. Format is as in Figure 2, A. C, Unadjusted. Format for Kaplan-Meier estimates is as in Figure 2, A. D, Adjusted. Variables as in Figure 2, B except that complete revascularization with ≥50% stenosis was simulated for both men and women. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 571-579.e9DOI: (10.1016/j.jtcvs.2016.11.033) Copyright © 2016 Terms and Conditions

Figure 5 Unadjusted survival after coronary artery bypass grafting stratified by sex and single versus bilateral internal thoracic artery grafting. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 571-579.e9DOI: (10.1016/j.jtcvs.2016.11.033) Copyright © 2016 Terms and Conditions

Figure E1 Temporal decomposition of instantaneous risk (hazard) of death for women and men. A, Individual hazard phases, showing a rapidly declining early phase and a late rising phase. Concomitant information shrinks or expands the area under the early hazard phase and tilts the late hazard phase. B, As in A, but on expanded horizontal scale. C, Hazard phases added. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 571-579.e9DOI: (10.1016/j.jtcvs.2016.11.033) Copyright © 2016 Terms and Conditions

Figure E2 Use of ITA grafting by operative year. A, Use of any ITA graft accelerated in the early 1980s, and use of BITA grafting increased at that time, but on average has remained about 20% of cases. B, BITA grafting was more common in men than women throughout the study period. ITA, Internal thoracic artery; BITA, bilateral internal thoracic artery; CABG, coronary artery bypass grafting. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 571-579.e9DOI: (10.1016/j.jtcvs.2016.11.033) Copyright © 2016 Terms and Conditions

Figure E3 Persistence of risk-unadjusted survival for women and men after coronary artery bypass grafting. Kaplan-Meier estimates, with 68% confidence limits shown at 5-year intervals. A, 1970s. B, 1980s. C, 1990s. D, 2000s. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 571-579.e9DOI: (10.1016/j.jtcvs.2016.11.033) Copyright © 2016 Terms and Conditions

Figure E4 Survival in men and women according to revascularization strategy across the decades. Format is as in Figure E3. A, 1970s. B, 1980s. C, 1990s. D, 2000s. SITA, Single internal thoracic artery graft; ITA, internal thoracic artery graft; BITA, Bilateral internal thoracic artery graft. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 571-579.e9DOI: (10.1016/j.jtcvs.2016.11.033) Copyright © 2016 Terms and Conditions

Figure E5 Temporal trend in patient demographics and comorbidities. Percentages by decade are depicted. Left-hand blue bars represent prevalences in men and right-hand red bars those in women. For age and BMI, box includes 25th and 75th percentiles, horizontal bar within box is the median, whiskers encompass values within 1.5 of IQR, and individual dots are extreme values. BMI, Body mass index. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 571-579.e9DOI: (10.1016/j.jtcvs.2016.11.033) Copyright © 2016 Terms and Conditions

Unadjusted survival after coronary artery bypass grafting stratified by sex and single versus bilateral internal thoracic artery grafting. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 571-579.e9DOI: (10.1016/j.jtcvs.2016.11.033) Copyright © 2016 Terms and Conditions