Two Decades of Coronary Artery Bypass Grafting in Women: Has Anything Changed?

Background: Studies have shown that women have worse outcomes after coronary artery bypass grafting (CABG); it is unclear whether this knowledge has led to improved outcomes over time. This study sought to examine temporal trends in women undergoing CABG.

Methods: From 2000 to 2021, 9062 women underwent isolated CABG at a single institution. The institutional Society of Thoracic Surgeons database was queried for preoperative, intraoperative, and postoperative variables. The cohort was stratified by date of operation into 6 groups coinciding with versions of The Society of Thoracic Surgeons database: 2002-2004/version 2.41 (n = 1348 [15%]), 2004-2007/version 2.52 (n = 2413 [27%]), 2008-2011/version 2.61 (n = 2244 [25%]), 2011-2014/version 2.73 (n = 1230 [14%]), 2014-2017/version 2.81 (n = 783 [9%]), and 2017-2021/version 2.9 (n = 1044 [12%]).

Results: The median age was 66 (interquartile range, 58-74) years. Comorbid conditions including chronic lung disease, cerebrovascular disease, diabetes, hypertension, and heart failure increased over time. The number of urgent CABG procedures increased from 20% in the 2002-2004 group to 66% in the 2017-2021 group, whereas the number of elective CABG procedures decreased from 76% to 32% ( < .001). From 2002-2004 to 2017-2021, internal mammary artery use increased from 85% to 92% ( < .001). Mortality did not improve for women over time, in-hospital mortality was significantly higher for women (3.6%) than for men (1.8%; < .001), and the gap between women and men remained unchanged over time.

Conclusions: Mortality of women undergoing CABG at our institution (3.6%) remains higher than the overall national average (∼2%) and that of the male institutional cohort (1.8%). Further studies to understand this disparity and to improve care for women undergoing CABG are needed.