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

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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