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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.

Robert H. Habib, PhD
robert_habib@mhsnr.org
Department of Medicine

Anoar Zacharias, MD; Thomas A. Schwann, MD; Christopher J. Riordan, MD; Samuel J. Durham, MD; Aamir Shah, MD
Department of Surgery
Medical College of Ohio
Toledo

1. King KM, Ghali WA, Faris PD, et al. Sex differences in outcomes after cardiac catheterization: effect modification by treatment strategy and time. JAMA. 2004;291:1220-1225. FREE FULL TEXT 2. Koch CG, Khandwala F, Nussmeier N, Blackstone EH. Gender and outcomes after coronary artery bypass grafting: a propensity-matched comparison. J Thorac Cardiovasc Surg. 2003;126:2032-2043. FREE FULL TEXT

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;292:40-41.

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