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July 7, 2004

Sex Differences in Mortality After Coronary Artery Bypass Graft Surgery

JAMA. 2004;292(1):40-41. doi:10.1001/jama.292.1.40-c

Dr King and colleagues1 reported that women had a higher risk of death than men immediately following coronary artery bypass graft (CABG) surgery, but that the risk of death was equal for men and women after 1 year. The authors used graphic analysis rather than Cox regression because the results violated the proportional hazard assumptions of the Cox model. We are concerned that the results of this analysis reflect residual confounding due to the reported baseline differences in demographic factors and comorbid conditions, rather than an independent effect of sex. For instance, Koch et al2 reported that early mortality after CABG surgery was higher in women but that this difference disappeared after propensity matching for demographic factors, risk factors, medications, coronary disease, and cardiopulmonary bypass.