Key result
Women undergoing CABG face worse baseline risks, less complete revascularization, and more perioperative complications than men.
Why the study?
Although evidence on gender effects on outcomes is controversial, multiple publications have reported less favorable outcomes of CABG in women, prompting a review of factors worsening their short- and long-term prognosis.
Do women have worse short- and long-term outcomes compared to men after undergoing CABG?
Do women have worse short- and long-term outcomes compared to men after undergoing CABG?
Women undergoing CABG face worse short- and long-term prognoses than men, highlighting the need for sex-specific risk models and improved revascularization strategies.
In recent years, there has been an increase in the number of women undergoing coronary artery bypass grafting (CABG). Although the evidence of gender effects on outcomes is controversial, a number of publications have reported less favorable outcomes of CABG in women. The aim of this paper was to review the literature regarding factors that worsen short- and long-term prognosis in women undergoing surgical myocardial revascularization. Gender differences in early outcomes of CABG are largely explained by gender distribution of baseline clinical characteristics. Women, compared to men, undergo CABG at an older age and have a worse profile of cardiovascular disease (CVD) risk factors (RF), comorbidity burden, structural and functional cardiac pathology, and coronary lesions. In women, complete myocardial revascularization is less frequent than in men, venous shunts are used more frequently, and the left internal mammary artery is less frequently used as a conduit. In addition to the baseline characteristics, higher incidence of perioperative myocardial infarction (MI), higher prevalence of anxiety and depression, lower quality of life and social adaptation after CABG, and lower involvement of women in rehabilitation programs, compared to men, may contribute to a less favorable long-term prognosis after CABG in women. There is a need for more information for physicians about the specifics of CVDs and anatomical and surgical aspects of CABG in women. It is also necessary to raise patients’ awareness of RF correction and to involve them in educational technologies. Recommendations for diagnosis and treatment of CVDs should be developed taking into account gender. Further research is also required to develop and implement sex-specific models for predicting surgical risks. Long-term follow-up is appropriate in women with recent MI and a history of diabetes mellitus. To further improve clinical outcomes of CABG in women, development of approaches that facilitate more complete revascularization and reduce the incidence of perioperative complications, such as MI and pneumonia, is needed. More answers to questions regarding gender differences in long-term outcomes of CABG may be obtained by analyzing further studies involving a larger number of female patients.
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Serebryakova et al. (2023) conducted a review in Coronary artery disease requiring CABG. Female gender vs. Male gender was evaluated on Short- and long-term prognosis after CABG. Women undergoing CABG have a worse baseline risk profile, receive less complete revascularization, and experience higher rates of perioperative complications compared to men.
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