A recent study published in JAMA Surgery sheds light on the significant disparities in outcomes for women undergoing coronary artery bypass grafting (CABG), the most common cardiac procedure in the US.
Dr Mario Gaudino and his colleagues conducted the study, analysing data from over one million patients who underwent primary isolated CABG between 2011 and 2020.
The key findings indicate that women continue to face higher operative mortality and a greater incidence of the composite of operative mortality and morbidity compared to men.
The study revealed that the attributable risk of female sex for operative mortality ranged from 1.28 in 2011 to 1.41 in 2020, with no significant improvement over the decade.
Similarly, the attributable risk for the composite outcome showed no significant change, remaining at 1.08 in both 2011 and 2020.
CABG, a procedure involving the restoration of blood flow by bypassing blocked vessels, is performed on 200,000-300,000 individuals annually in the US, making it the most common cardiac operation.
Approximately 25-30% of CABG patients are women.
Despite the procedure’s low mortality rate, women face a higher mortality rate (2.8%) compared to men (1.%).
Dr Mario Gaudino is a cardiothoracic surgeon at Weill Cornell Medicine and the study’s lead author.
He said several factors help explain the disparities. Women are three to five years older than men when they undergo bypass surgery, in part because ‘we recognise coronary artery disease more easily and earlier in men’.
He added: ‘Men have the classic presentation we study in medical school. Women have different symptoms.’
These may include fatigue, shortness of breath and pain in the back or stomach.
Fewer than 20% of patients enrolled in clinical trials have been female, so ‘what we’ve been taught is essentially based on research in men’, he added.
Partly because they’re older – about 40 per cent are over 70 – women are more apt than men to have developed health problems like diabetes, high blood pressure and vascular conditions, ‘all factors that increase risk in cardiac surgery’, Dr Gaudino said. They also have smaller, more fragile blood vessels, which can make surgery more complex.
Experts express concern about the persistent gender gap in CABG outcomes, highlighting the need for further investigation into the determinants of these disparities.
The study has prompted calls for improved care and tailored approaches for women undergoing cardiac surgery.
While outcomes improved for both sexes over the study period, the gender disparities in CABG outcomes underscore the urgency for targeted research and interventions to address the unique challenges women face in cardiac procedures.
Ongoing clinical trials, such as the international ROMA study and the federally funded Recharge trial, aim to explore potential solutions and minimise these disparities.
Advocates emphasise the importance of recognising and addressing these issues to improve the overall outcomes for women undergoing heart surgery.
