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Women less likely than men to get complete revascularization in CABG
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Among patients undergoing CABG, women had less complete multiple arterial revascularization than men, likely due to women having later presentation of CAD, researchers reported in the Annals of Thoracic Surgery.
"It appears that by the time women present with heart disease, they are slightly older and may be facing more comorbidities such as obesity and diabetes," Fraser D. Rubens, MD, of the University of Ottawa Heart Institute, said in a press release. "As a consequence, these higher operative risks may preclude women from undergoing the more complex multiple arterial revascularization procedures that men receive."
Rubens and colleagues analyzed 19,557 patients who underwent isolated CABG to determine changes in sex-specific rates of revascularization approaches between 1990 and March 2015. They created a propensity-matched cohort of 627 men and 627 women for certain analyses.
Sex differences
Among the entire cohort, male sex was linked to increased use of bilateral internal thoracic artery (OR = 1.667; 95% CI, 1.166-2.386), according to the researchers.
Although multiple-arterial grafting increased each year in both sexes, the rate of increase was higher in men vs. women (men, 1.59% per year; 95% CI, 1.56-1.63; women, 1.37% per year; 95% CI, 1.3-1.45; P for interaction < .001).
Similar trends were seen in increases in the use of three arteries (men, 1.16% per year; 95% CI, 1.13-1.2; women, 0.73% per year; 95% CI, 0.67-0.8; P for interaction < .001) and in the use of any two arteries (men, 2.34% per year; 95% CI, 2.32-2.35; women, 1.92% per year; 95% CI, 1.9-1.95; P for interaction < .001).
In the propensity-matched group, there were no differences between the sexes in use of the bilateral internal thoracic artery (men, 31.9%; women, 30.1%; P = .502), use of the bilateral internal thoracic artery in low-risk patients (men, 46.4%; women, 38%; P = .126) or use of the radial artery (men, 44.5%; women, 44.1%; P = .944), but use of three arteries was more common in men (10.5% vs. 7.3%; P = .048), according to the researchers.
"Most clinicians assume correctly that women are less likely to receive multiple arterial revascularization, but they tend to believe that this is solely on the basis of a gender bias," Rubens said in the release. "The current study shows that gender does not play a significant role in this decision. There is no reason that, when adjusted for all risk factors, the degree of multiple arterial revascularization in women should be any different than what men receive."
Early diagnosis key
More likely, the researchers wrote, women are not getting diagnosed with CAD as quickly as men, perhaps because tests such as exercise treadmills are not as accurate in women as in men.
"With earlier diagnoses, women could be referred for revascularization as healthier surgical candidates, affording them the opportunity of complete arterial revascularization strategies with better postoperative outcomes," Rubens said in the release. "This study has given us the confidence to continue educating surgeons on the feasibility of multiple arterial revascularization and to ensure that this choice of surgical strategy be based on patient risk profiles and not solely on gender." – by Erik Swain
Disclosures: The authors report no relevant financial disclosures.
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