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Intraoperative Anemia Mediates Sex Disparity in Operative Mortality After Coronary Artery Bypass Grafting.

Harik, Lamia (author)
Habib, Robert H (author)
Dimagli, Arnaldo (author)
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Rahouma, Mohamed (author)
Perezgrovas-Olaria, Roberto (author)
Jr Soletti, Giovanni (author)
Alzghari, Talal (author)
An, Kevin R (author)
Rong, Lisa Q (author)
Sandner, Sigrid (author)
Bairey-Merz, C Noel (author)
Redfors, Björn (author)
Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine
Girardi, Leonard (author)
Gaudino, Mario (author)
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 (creator_code:org_t)
2024
2024
English.
In: Journal of the American College of Cardiology. - 1558-3597. ; 83:9, s. 918-928
  • Journal article (peer-reviewed)
Abstract Subject headings
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  • Women undergoing coronary artery bypass grafting (CABG) have higher operative mortality than men.The purpose of this study was to evaluate the relationship between intraoperative anemia (nadir intraoperative hematocrit), CABG operative mortality, and sex.This was a cohort study of 1,434,225 isolated primary CABG patients (344,357 women) from the Society of Thoracic Surgeons Adult Cardiac Surgery Database (2011-2022). The primary outcome was operative mortality. The attributable risk (AR) (the risk-adjusted strength of the association of female sex with CABG outcomes) for the primary outcome was calculated. Causal mediation analysis derived the total effect of female sex on operative mortality risk and the proportion of that effect mediated by intraoperative anemia.Women had lower median nadir intraoperative hematocrit (22.0% [Q1-Q3: 20.0%-25.0%] vs 27.0% [Q1-Q3: 24.0%-30.0%], standardized mean difference 97.0%) than men. Women had higher operative mortality than men (2.8% vs 1.7%; P< 0.001; adjusted OR: 1.36; 95%CI: 1.30-1.41). The AR of female sex for operative mortality was 1.21 (95%CI: 1.17-1.24). After adjusting for nadir intraoperative hematocrit, AR was reduced by 43% (1.12; 95%CI: 1.09-1.16). Intraoperative anemia mediated 38.5% of the increased mortality risk associated with female sex (95%CI: 32.3%-44.7%). Spline regression showed a stronger association between operative mortality and nadir intraoperative hematocrit at hematocrit values <22.0% (P< 0.001).The association of female sex with increased CABG operative mortality is mediated to a large extent by intraoperative anemia. Avoiding nadir intraoperative hematocrit values below 22.0% may reduce sex differences in CABG operative mortality.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Keyword

Adult
Humans
Female
Male
Cohort Studies
Coronary Artery Bypass
adverse effects
Anemia
epidemiology
Cardiac Surgical Procedures
Hematocrit
Risk Factors
Treatment Outcome
Retrospective Studies

Publication and Content Type

ref (subject category)
art (subject category)

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