Introduction:

ischemic heart disease is the leading cause of death in both sexes, and coronary revascularization is the most common cardiac procedure worldwide. Women, representing 20-30% of coronary artery bypass grafting (CABG) surgeries, tend to experience worse clinical outcomes, including higher mortality and increased severe postoperative complications such as stroke and myocardial infarction (MI).

Objectives:

to evaluate long-term outcomes of CABG in women, identifying clinical predictors of an adverse prognosis.

Methods:

retrospective, observational study. Ethics Committee approved. Data were collected from the National Resource Fund on 21,959 isolated CABG procedures performed in Uruguay between 2003 and 2022. Quantitative variables were compared using t-tests and categorical variables with Chi-square test. Outcomes were adjusted for demographic variables using logistic and Cox regression. Subgroup and interaction analyses were performed using the Mantel-Haenszel test to calculate odds ratios. Statistical significance was set at 0.05.

Results:

most variables showed significant differences between sexes. Women had higher age, diabetes, prior stroke, dyslipidemia, hypertension, 1- and 2-vessel disease, left ventricular ejection fraction, more unstable angina, and higher EuroSCORE I. They also had higher operative mortality (4.7% vs. 3.5%; p < 0.001), stroke (1.5% vs. 1.2%; p = 0.02), and postoperative MI (3.2% vs. 2.3%; p < 0.001). Adjusted survival showed no significant differences (HR = 0.96; 95% CI: 0.91-1.01; p = 0.11). Adjusted operative mortality was higher in women (OR = 1.5; 95% CI: 1.27-1.73; p < 0.001).

Conclusions:

women undergoing CABG had more comorbidities and higher operative risk, with greater operative mortality and postoperative complications. However, being female was not an independent predictor of long-term mortality.

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