{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T02:59:43Z","timestamp":1772506783466,"version":"3.50.1"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2022,9,23]],"date-time":"2022-09-23T00:00:00Z","timestamp":1663891200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>Several of the most extensively used risk prediction tools for coronary artery bypass grafting outcomes include female sex as an independent risk factor for postoperative outcomes. It is not clear whether this putative increased surgical risk impacts long-term survival. This study aimed to assess sex differences in 10-year all-cause mortality.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>Retrospective analysis of 5340 consecutive patients undergoing primary isolated coronary artery bypass surgery, performed from 2000 to 2015, in a Portuguese level III Hospital. The primary endpoint was all-cause mortality at ten years. We employed an overlap weighting algorithm to minimize confounding. Its target population highlights patients with the most overlap in their observed characteristics, and its corresponding estimand is the average treatment effect in the overlap population.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>We identified that 5340 patients underwent isolated CABG: 1104 (20.7%) were female, and 4236 (79.3%) were male. Sixteen patients were lost to follow-up (0.3%). The median follow-up time was 12.79 (IQR, 9.52\u201316.66) years: 12.68 (IQR, 9.48\u201316.54) years for the male patient group and 13.13 (IQR, 9.75\u201316.98) years for the female patient group. The primary endpoint of all-cause mortality at ten years occurred in 1106 patients (26.1%) in the male patient group, compared with 315 (28.5%) in the female patient group. The unweighted survival analysis for both groups reveals the worst long-term prognosis for the female cohort (hazard ratio, 1.22; 95% CI, 1.10 to 1.35; p &lt; 0.001), while in the overlap weighted survival analysis, such long-term difference in prognosis disappears (hazard ratio, 0.98; 95% CI, 0.88 to 1.09; p = 0.693).<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusion<\/jats:title><jats:p>In this longitudinal, population-level analysis of patients undergoing primary, isolated CABG, we demonstrated that the female sex is not associated with increased long-term all-cause mortality compared to their male counterparts. Thus, sex should not influence the undertaking of an adequate revascularization strategy.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0275035","type":"journal-article","created":{"date-parts":[[2022,9,23]],"date-time":"2022-09-23T18:06:03Z","timestamp":1663956363000},"page":"e0275035","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":9,"title":["Long-term survival of female versus male patients after coronary artery bypass grafting"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4876-5179","authenticated-orcid":true,"given":"Armando","family":"Abreu","sequence":"first","affiliation":[]},{"given":"Jos\u00e9","family":"M\u00e1ximo","sequence":"additional","affiliation":[]},{"given":"Adelino","family":"Leite-Moreira","sequence":"additional","affiliation":[]}],"member":"340","published-online":{"date-parts":[[2022,9,23]]},"reference":[{"issue":"3","key":"pone.0275035.ref001","first-page":"715","article-title":"The role of gender in coronary surgery","volume":"40","author":"JD Blasberg","year":"2011","journal-title":"Eur J Cardiothorac Surg"},{"issue":"3","key":"pone.0275035.ref002","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1016\/S0003-4975(00)01563-0","article-title":"The influence of gender on the outcome of coronary artery bypass surgery","volume":"70","author":"D Abramov","year":"2000","journal-title":"Ann Thorac Surg"},{"issue":"1","key":"pone.0275035.ref003","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/S0003-4975(98)00358-0","article-title":"Impact of gender on coronary bypass operative mortality","volume":"66","author":"FH Edwards","year":"1998","journal-title":"Ann Thorac Surg"},{"issue":"4","key":"pone.0275035.ref004","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/j.cjca.2018.01.087","article-title":"Coronary Surgery in Women and the Challenges We Face","volume":"34","author":"R Hessian","year":"2018","journal-title":"Can J Cardiol"},{"issue":"4","key":"pone.0275035.ref005","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1093\/ejcts\/ezs043","article-title":"EuroSCORE II","volume":"41","author":"SA Nashef","year":"2012","journal-title":"Eur J Cardiothorac Surg"},{"issue":"5","key":"pone.0275035.ref006","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1016\/j.athoracsur.2018.03.002","article-title":"The Society of Thoracic Surgeons 2018 Adult Cardiac Surgery Risk Models: Part 1-Background, Design Considerations, and Model Development","volume":"105","author":"DM Shahian","year":"2018","journal-title":"Ann Thorac Surg."},{"issue":"5","key":"pone.0275035.ref007","first-page":"1419","article-title":"The Society of Thoracic Surgeons 2018 Adult Cardiac Surgery Risk Models: Part 2-Statistical Methods and Results","volume":"105","author":"SM O\u2019Brien","year":"2018","journal-title":"Ann Thorac Surg."},{"issue":"3","key":"pone.0275035.ref008","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.amjcard.2013.03.034","article-title":"Comparison by meta-analysis of mortality after isolated coronary artery bypass grafting in women versus men","volume":"112","author":"M Alam","year":"2013","journal-title":"Am J Cardiol"},{"issue":"1","key":"pone.0275035.ref009","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1016\/j.atherosclerosis.2015.02.039","article-title":"Long-term outcome in men and women after CABG; results from the IMAGINE trial","volume":"241","author":"HM den Ruijter","year":"2015","journal-title":"Atherosclerosis"},{"issue":"1","key":"pone.0275035.ref010","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1186\/s13019-016-0538-4","article-title":"Gender differences in outcomes following isolated coronary artery bypass grafting: long-term results","volume":"11","author":"F Nicolini","year":"2016","journal-title":"J Cardiothorac Surg"},{"issue":"8","key":"pone.0275035.ref011","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1161\/CIRCULATIONAHA.117.030526","article-title":"Sex Difference in Patients With Ischemic Heart Failure Undergoing Surgical Revascularization: Results From the STICH Trial (Surgical Treatment for Ischemic Heart Failure)","volume":"137","author":"IL Pi\u00f1a","year":"2018","journal-title":"Circulation"},{"issue":"1","key":"pone.0275035.ref012","first-page":"250","article-title":"Addressing Extreme Propensity Scores via the Overlap Weights","volume":"188","author":"F Li","year":"2019","journal-title":"Am J Epidemiol"},{"key":"pone.0275035.ref013","doi-asserted-by":"crossref","first-page":"648","DOI":"10.21105\/joss.00648","article-title":"comorbidity: An R package for computing comorbidity scores","volume":"3","author":"A. 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