What is the clinical evidence from this study?

Study design: Cohort. Population: Single-vessel or LAD-predominant coronary artery disease (n=350). Intervention: Female sex vs. Male sex. Primary outcome: All-cause long-term mortality (HR 0.80, 95% CI 0.38-1.70, p=0.560).

What does this research mean for the field?

Minimally invasive direct coronary artery bypass (MIDCAB) confers equivalent perioperative safety and long-term survival in women and men, demonstrating that female sex is not an independent predictor of adverse outcomes for this procedure. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

To evaluate whether female sex remains an independent risk factor for adverse short- and long-term outcomes following minimally invasive direct coronary artery bypass (MIDCAB).

September 5, 2026Journal of Clinical MedicineOpen Access

Sex Disparities in Outcomes After Minimally Invasive Direct CABG for Single-Vessel Disease: A Propensity Score-Matched Analysis

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Key result

Female sex shows no difference in long-term mortality compared to male sex after MIDCAB.

HR 0.80
95% CI 0.38-1.70
P=0.560
n=350

Why the study?

Does female sex increase the risk of all-cause long-term mortality in patients undergoing MIDCAB?

Population

350 consecutive patients undergoing MIDCAB at a single centre

Comparison

Females vs males

Design

Retrospective propensity score-matched cohort study

Follow-up

Median 19.0 years

Authors

LALukman AmanovInterventional / Structural Cardiology ARArian Arjomandi RadCardiac Surgery SASadeq Ali-Hasan-Al-SaeghMedizinische Hochschule Hannover

Discussion

Member takes

Implication

Supports equivalent long-term survival after MIDCAB in women and men; extends observational MIDCAB data but leaves open randomized confirmation.

Key Points

To evaluate whether female sex remains an independent risk factor for adverse short- and long-term outcomes following minimally invasive direct coronary artery bypass (MIDCAB).
Retrospective single-center analysis of 350 consecutive patients undergoing off-pump MIDCAB at Hannover Medical School between July 1999 and April 2025, followed for a median of 19.0 years.
Greedy 1:1 nearest-neighbor propensity score matching using a 0.2 caliper matched 100 females to 100 males to evaluate perioperative complications and long-term all-cause mortality.
At a median follow-up of 19.0 years, all-cause mortality was 12.0% in females versus 12.0% in males (p = 1.000; log-rank p = 0.703; multivariable adjusted HR 0.80, 95% CI 0.38–1.70, p = 0.560).
Thirty-day mortality was 0% in both sexes with zero intraoperative conversions, while re-exploration for bleeding was 5.0% in women versus 0.0% in men (risk difference Newcombe 95% CI +0.3% to +11.2%, p = 0.059).

Study Design

Type

Cohort (n=350)

Multicenter

Structured PICO

Does female sex increase the risk of all-cause long-term mortality in patients undergoing MIDCAB?

Population

350 adults with single-vessel or LAD-predominant coronary artery disease undergoing MIDCAB, mean age 64, 29.1% female, followed for a median of 19.0 years.

Exposure

Female sex (exposure)

Comparator

Male sex

Outcome

All-cause long-term mortality at median 19.0 years follow-uphard clinical

Main Result

Hazard Ratio: 0.8 (95% CI 0.38–1.7)

Absolute Event Rate: 12% vs 12%

p-value: p=0.560

MIDCAB provides equivalent long-term survival and perioperative safety for both women and men, challenging the historical view that female sex is an independent risk factor for adverse outcomes after surgical revascularization.

Limitations

Retrospective, single-centre design
Small number of female patients limiting statistical power for rare events
Lack of systematic recording of NYHA, BMI, and alcohol use
Incomplete structured angiographic follow-up
Enrollment concentrated in earlier years of the 26-year study period
Small number of female patients
Missing data for NYHA, BMI, and alcohol use
Enrollment concentrated in earlier years

Cite This Study

Amanov et al. (2026) conducted a cohort in Single-vessel or LAD-predominant coronary artery disease (n=350). Female sex vs. Male sex was evaluated on All-cause long-term mortality (HR 0.80, 95% CI 0.38-1.70, p=0.560). Female sex was not associated with an increased risk of long-term all-cause mortality after MIDCAB compared to male sex (adjusted HR 0.80, 95% CI 0.38-1.70, p=0.560).

synapsesocial.com/papers/6a9bd4346b95aff0620ebb2f https://doi.org/10.3390/jcm15176821

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Implication

Supports equivalent long-term survival after MIDCAB in women and men; extends observational MIDCAB data but leaves open randomized confirmation.

Sex Disparities in Outcomes After Minimally Invasive Direct CABG for Single-Vessel Disease: A Propensity Score-Matched Analysis

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Sex Disparities in Outcomes After Minimally Invasive Direct CABG for Single-Vessel Disease: A Propensity Score-Matched Analysis

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider