Title: Early Menopause as an Independent Risk Factor for Postoperative Atrial Fibrillation in
Women Undergoing Coronary Artery Bypass Grafting: A Retrospective Cohort Study
Version: 2 Date: 06 May 2025
Reviewer's report:
Your study compares the correlation between the occurrence of atrial fibrillation (AF) after
coronary artery bypass grafting (CABG) in women with premature menopause and those without
premature menopause. The study employs retrospective analysis and cohort research, which is
meaningful and valuable. However, there are still some issues that need to be addressed:
1. In the Introduction, there is no explanation for why the study focuses on the correlation
between CABG and menopause. There are many possibilities and reasons for the occurrence
of AF after cardiac surgery. Please explain why only AF after CABG surgery was chosen as
the outcome measure.
2. AF after cardiac surgery is a relatively common postoperative complication, and there are
already effective treatment methods available. In the second paragraph of the Introduction, the
authors claim that new-onset AF or flutter lasting at least one hour after surgery increases the
incidence of adverse cardiovascular events. Is this view an overstatement of the facts? Please
provide the latest references or guidelines to support this statement.
3. The authors define menopause occurring before the age of 45 as premature menopause.
However, the menopausal period for most women usually occurs between the ages of 49 and
52. What about menopause occurring between the ages of 45 and 49? Is it considered premature
menopause? Please explain how to determine whether menopause in this age range is premature.
4. Should the inclusion and exclusion criteria consider women who have experienced premature
menopause due to hormones or the use of hormonal medications? Should factors such as
hysterectomy or other conditions that threaten women's health be taken into account? In short,
the inclusion and exclusion criteria should be more detailed.
5. Should patients undergoing CABG surgery be assessed preoperatively for the presence of AF
or other factors that may induce AF? Were antiarrhythmic drugs taken preoperatively?
6. The study includes patients who underwent surgery from January 2020 to December 2023.
It has been two years since then. Have the authors continued to follow up with these patients?
This would be of significant importance to the study.
7. In the Discussion section, the authors should thoroughly discuss the differences between
women with menopause and those without menopause in terms of coronary artery disease
(CAD). Based on these differences, further discussion should be conducted on the reasons for
CAD caused by menopause and the occurrence of AF after CABG surgery.
8. The authors still need to clarify whether age is the fundamental cause of the increased
incidence of AF after CABG surgery. This is the most important question readers are eager to
know. Please provide a detailed explanation.
9. In the second paragraph of the Discussion section, please provide the latest references and
guidelines to support your views. The format of the reference section still needs to be modified,
with additional and updated references added.
10. In the Conclusion section, the authors should provide recommendations or reminders for
the treatment or prevention of AF in such patients. They should also advise cardiac surgeons to
pay close attention to patients' menstrual history preoperatively and to prevent the occurrence
of AF after surgery.