This study examined sex differences in isolated coronary artery bypass grafting (CABG) over 20 years (2001-2021) at a single centre, with 1:1 propensity score matching (2,573 women vs 2,573 men). Women were older and more often had class III-IV angina, hypertension and diabetes. After matching, women received fewer left internal mammary artery (LIMA) grafts (84% vs 88%) and fewer total grafts (median 2 vs 3), had higher in-hospital mortality (2.2% vs 1.3%; OR 1.74) and longer hospital stays. Twenty-year survival, however, was similar. Off-pump CABG lowered in-hospital mortality in women (1.6% off-pump vs 3.0% on-pump). Women thus have higher perioperative risk and receive fewer (arterial) grafts, while long-term survival is equal — arguing for a female-tailored perioperative approach.
To evaluate sex differences in perioperative characteristics, in-hospital outcomes and long-term survival following coronary artery bypass grafting (CABG).
Prospective data were collected for all patients undergoing isolated CABG at a single centre during 2001–2021. Baseline characteristics were adjusted between females and males using 1:1 propensity score matching (nearest-neighbour, without replacement). Kaplan-Meier analysis assessed long-term survival. A predefined sub-analysis assessed risk mitigation associated with using off-pump CABG (OPCABG) in females in the matched cohort.
Prematching, 11 563 males and 2573 females were included. Females were older with higher prevalences of class III–IV angina, hypertension and diabetes. After matching, 2573 patients per group were analysed, with standardised mean differences <0.1 for all covariates. Females had fewer left internal mammary artery (LIMA) grafts (84% vs 88%, p<0.001), fewer total grafts (median 2 vs 3, p<0.001), higher in-hospital mortality (2.2% vs 1.3%, OR 1.74, 95% CI 1.14 to 2.71, p=0.011) and longer hospital stays (median 7 days vs 6 days, beta 0.51, 95% CI 0.12 to 0.90, p=0.01). Long-term survival was similar (stratified log-rank p=0.79). OPCABG mitigated the risk of in-hospital mortality in females (1.1% males vs 1.6% females, OR 0.69, 95% CI 0.33 to 1.43, p=0.32; 1.6% OPCABG females vs 3.0% on-pump females, OR 0.53, 95% CI 0.31 to 0.91, p=0.021).
Females suffer higher in-hospital mortality and receive fewer LIMA and total number of grafts than males; however, 20-year survival is similar. OPCABG protects females from in-hospital mortality. A new female-tailored peri-operative care approach is warranted for females undergoing CABG.
