Influence of sex and age on long-term survival in systematic off-pump coronary artery bypass surgery
Bibliographic record
Abstract
BACKGROUND: Off-pump coronary artery bypass surgery (OPCAB) is commonly used as an alternative to conventional on-pump coronary artery revascularization. Historically, sex and age have been shown to adversely affect operative mortality risk as well as long-term survival in conventional surgery. AIMS OF THE STUDY: To evaluate the effect of gender and ageing on long-term mortality following OPCAB surgery. METHODS: We have prospectively followed up 1000 consecutive and systematic OPCAB patients operated between September 1996 and April 2003. Average follow-up period was 64+/-28 months and was complete in 98% of the cohort. RESULTS: There were 223 women (21%) and 777 men (79%). Women were older, 68+/-10 versus 63+/-10 years (p<0.0001) and had higher prevalence of hypertension (p<0.0001), peripheral vascular disease (PVD) (p=0.03), recent myocardial infarction (p=0.04) and a smaller body surface (p<0.0001). History of congestive heart failure (CHF) (p=0.001) and unstable angina (p=0.003) was more frequent in men. Operative mortality was 2.8% in women and 1.4% in men (p=ns). Eight-year survival was 79+/-2.5% for men and 68+/-5% for women, (p=0.02). Cox regression analysis model revealed that age (HR: 2.81; 95% CI: 1.89-4.18), CHF (HR: 2.09; 95% CI: 1.33-3.31), PVD (HR: 1.72; 95% CI: 1.10-2.5), incomplete revascularization (HR: 2.35; 1.37-4.02), multiple internal thoracic artery (MITA) graft/patient (ITA/pt) (HR: 0.61; 95% CI: 0.44-0.84), left ventricular ejection fraction (LVEF) (HR: 0.19; 95% CI: 0.05-0.71) and cerebral vascular disease (HR: 1.50; 95% CI: 1.00-2.24) but not female sex (p=0.89) were significant predictors of long-term mortality. Above 65 years of age men and women had a comparable overall survival (p=0.7) whereas fewer than 65 women had a lower survival than men (p=0.001). Cox regression revealed that LVEF (HR: 0.06; 95% CI: 0.006-0.59), lesser use of MITA graft (HR: 0.45; 95% CI: 0.35-0.79), were significant causes of long-term mortality in the younger cohort. Female gender did not reach statistical significance (p=0.12). CONCLUSION: In this series of systematic OPCAB surgery, the lower survival rate observed in younger women was mostly related to a higher prevalence of preoperative comorbidity and a lesser use of MITA grafts than gender itself.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".