| Objective Recently,studies focusing on whether female gender per se is an independent risk factor for in-hospital mortality after coronary artery bypass grafting(CABG) only include patients from United States, Australia, Switzerland or other european countries. Multicenter large-scale studies investigating the impact of female gender per se on post-CABG in-hospital mortality in Chinese patients are still lacking.Meanwhile,there is not any meta-analysis to support women who underwent isolated CABG experienced higher in-hospital mortality at compared with men and mortality remained independently associated with female gender despite meta regression matched analysis of outcomes. To fill the knowledge gaps,the aim of the study is to investigate the independent risk factors for the mortality, the correlation between gender and post-CABG mortality in coronary artery diseases patients,espectially in Chinese patients, undergoing isolated CABG in Beijing.Methods In the epidemiological part, the medical records of patients undergoing CABG between January 1, 2006 and December 31, 2011 in Beijing were reviewed. Multivariate logistic regression and propensity score-matched analysis were performed to analyze whether female gender per se is an independent risk factor for in-hospital mortality after CABG.In the meta-analysis,we focus on patients from all the ethnic groups to investigate the same topic by means of the evidence-based clinical practice.Results A total of 35,173 Chinese patients undergoing isolated CABG in Beijing in 5 consecutive years were included in this study. There were 26,926(76.6%) men and 8247(23.4%) women. The mean age of women was significantly older than that of men(64.94 ± 7.84 years vs. 61.0 ± 9.4 years, P < 0.0001). Compared with men, significantly higher proportions of women presented the comorbidities hypertension(70.56% vs 57.76%, P < 0.0001), diabetes mellitus(36.15% vs 27.61%,P<0.0001), unstable angina(49.05% vs 42.30%,P<0.0001), or reflux esophagitis(0.78% vs. 0.51%, P = 0.0056) at hospital admission. In contrast, compared with women, markedly higher proportions of men had a history of carotid artery stenosis(1.21% vs 0.91%,P= 0.0257), or varicose great saphenous vein(0.17% vs. 0.07%, P = 0.0425) prior to CABG.Multivariate logistic regression analysis on the total patients revealed that female gender was not an independent risk factor for in-hospital mortality(Odds ratio [OR]: 0.933,95% confidence interval [CI]: 0.759-1.147) but age was(OR: 1.071, 95% CI:1.058-1.083, P < 0.0001). Although the in-hospital mortality of women was significantly higher than that of men(1.62% vs. 1.30%, P = 0.0248), regression analysis on the propensity score matched group also showed that female gender was not an independent risk factor(OR:1.051, 95%CI 0.698-1.583) for in-hospital mortality but age was(OR: 1.079,95% CI: 1.049-1.111, P < 0.0001).In the meta-analysis, a total of 21 articles including 201,465 patients met the inclusion criteria. The Q-statistic(P<0.0001) test and the I2 index(74.8%) demonstrated significant heterogeneity of the eligible studies. We found that women increased the incidence of in-hospital mortality by 81% undergoing CABG compared with the men (OR:1.81 95%CI:1.57-2.08,Z=8.32,P<0.001).A meta regression was performed to examine the source of heterogeneity. A total of 14 covariates were extracted from the included studies.We found that the women’s advancing age significantly modified the results.When we only focus on elderly women,no significant different was found between the two group.Conclusion This study found that age but not female gender was an independent risk factor for post-CABG in-hospital mortality in patients undergoing CABG,espectially Chinese patients undergoing CABG in Beijing. |
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