Long-term outcome in men and women after CABG; results from the IMAGINE trial.
BACKGROUND
The aim of this study is to determine sex differences in long-term outcome after coronary artery bypass grafting (CABG).


METHODS
The international randomized controlled IMAGINE study included 2553 consecutive patients with a left ventricular ejection fraction of >40% who underwent isolated CABG. Median follow-up was 32 months (IQR 17-42 months). The composite endpoint comprised of death, myocardial infarction (MI), cerebrovascular event, angina, revascularization and congestive heart failure. Cox regression analysis was used to examine sex differences in outcome post-CABG.


RESULTS
Of the 2553 patients, 2229 were men and 324 (13%) were women. Women were older and more often reported diabetes and hypertension. Smoking and impaired renal function were more prevalent in men. Women experienced a higher event rate during follow-up (composite endpoint 18% vs 12%; P = 0.007). Cox regression showed an increased risk of the composite endpoint in women after adjustment for age (HR 1.48 (95% CI: 1.11-1.97)) which was non-significant after additional adjustment for other confounders (HR 1.26 (95% CI: 0.92-1.72)).


CONCLUSIONS
Women have a worse long-term outcome after CABG than men in univariate analysis. However, after adjusting for potential confounders female sex became a non-significant predictor for prognosis, possibly due to the small sample size of women. Definite answers regarding sex-differences in long-term outcome after CABG should come from future pooling of studies comprising a larger number of women.
Experimental Cardiology Laboratory, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands.
Hester M
HM
den Ruijter
Experimental Cardiology Laboratory, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: s.haitjema@umcutrecht.nl.
Saskia
S
Haitjema
Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands.
Manon G
MG
van der Meer
Experimental Cardiology Laboratory, University Medical Center Groningen, Groningen, The Netherlands; Durrer Center for Cardiogenetic Research, Interuniversity Cardiology Institute Netherlands-Netherlands Heart Institute, Utrecht, The Netherlands.
Pim
P
van der Harst
Institute of Circulatory and Respiratory Health, Canadian Institutes of Health Research, University of Montreal, Montreal, Canada.
Jean L
JL
Rouleau
Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands; Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, United Kingdom; Durrer Center for Cardiogenetic Research, Interuniversity Cardiology Institute Netherlands-Netherlands Heart Institute, Utrecht, The Netherlands.
Folkert W
FW
Asselbergs
Experimental Cardiology Laboratory, University Medical Center Groningen, Groningen, The Netherlands.
Wiek H
WH
van Gilst
D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
CABG; Long-term outcome; Major adverse cardiac event; Sex