Michael Faith, Quevillon Travis, Betteridge-LeBlanc Suzanne, Alzahran Mustafa, Shehata Rafael, Jackevicius Cynthia A, Atoui Rony, Bittira Bindu, Baykaner Tina, Harvey Paula, Parkash Ratika, Healey Jeff S, Ko Dennis T, Shurrab Mohammed
Department of Cardiology, Health Sciences North, Northern Ontario School of Medicine University, 41 Ramsey Lake Rd, Sudbury, Ontario, Canada P3E 5J1.
Department of General Internal Medicine, Queen's University, 94 Stuart St, Kingston, Ontario, Canada K7L 2V7.
Eur Heart J Open. 2025 Apr 1;5(2):oeaf033. doi: 10.1093/ehjopen/oeaf033. eCollection 2025 Mar.
There is conflicting literature on sex differences and clinical outcomes in patients who develop atrial fibrillation (AF) post-cardiac surgery. Our aim was to compare clinical outcomes between females and males with post-cardiac surgery AF. A systematic search was conducted for studies published until 27 September 2024 in MEDLINE, Embase, and CENTRAL. Included studies compared mortality and stroke in females vs. males who developed AF after cardiac surgery. Outcomes of interest were mortality and stroke. Pooled prevalence was used to compare comorbidities. Raw event rates were used to calculate odds ratios (ORs), which were pooled with a fixed-effects model. 10 422 studies were identified and 5 studies met inclusion criteria. 14 970 patients who developed AF after cardiac surgery were included, of whom 3748 were females. The length of follow-up was up to 10 years. The weighted average age was 70.4 ± 2.9 years in females and 66.7 ± 2.4 years in males ( = 0.32). At baseline, females had a higher prevalence of hypertension, diabetes, dyslipidemia, stroke, and peripheral vascular disease. The odds of in-hospital mortality among females were higher compared to males (5.5 vs. 3.0%; OR 2.04, 95% CI 1.42-2.91, < 0.001, = 57%). There were no significant differences in post-discharge mortality (45.6 vs. 42.9%; OR 1.05, 95% CI 0.97-1.15, = 0.23, = 0%) or in-hospital stroke (2.5 vs. 1.9%; OR 1.30, 95% CI 0.79-2.13, = 0.30, = 57%) in females vs. males. In conclusion, females with post-cardiac surgery AF had a higher prevalence of comorbidities at baseline. The odds of in-hospital mortality were twice as high among females. There were no significant differences in post-discharge mortality or in-hospital stroke. Future studies are warranted to understand the mechanisms of increased in-hospital mortality in females and to develop effective monitoring strategies and interventions.
关于心脏手术后发生心房颤动（AF）的患者的性别差异和临床结局，文献报道存在冲突。我们的目的是比较心脏手术后发生AF的女性和男性的临床结局。我们对截至2024年9月27日在MEDLINE、Embase和CENTRAL上发表的研究进行了系统检索。纳入的研究比较了心脏手术后发生AF的女性与男性的死亡率和中风情况。感兴趣的结局是死亡率和中风。合并患病率用于比较合并症。原始事件发生率用于计算比值比（OR），并采用固定效应模型进行汇总。共识别出10422项研究，5项研究符合纳入标准。纳入了14970例心脏手术后发生AF的患者，其中3748例为女性。随访时间长达10年。女性的加权平均年龄为70.4±2.9岁，男性为66.7±2.4岁（P=0.32）。基线时，女性高血压、糖尿病、血脂异常、中风和外周血管疾病的患病率较高。女性住院死亡率的几率高于男性（5.5%对3.0%；OR 2.04，95%CI 1.42-2.91，P<0.001，I²=57%）。出院后死亡率（45.6%对42.9%；OR 1.05，95%CI 0.97-）或住院中风（2.5%对1.9%；OR 1.30，95%CI 0.79-2.13，P=0.30，I²=57%）在女性和男性之间无显著差异。总之，心脏手术后发生AF的女性在基线时合并症的患病率较高。女性住院死亡率的几率是男性的两倍。出院后死亡率或住院中风无显著差异。有必要进行进一步研究以了解女性住院死亡率增加的机制，并制定有效的监测策略和干预措施。 1.15，P=0.23，I²=0%）
