# Sex-related differences in single- and multi-arterial coronary artery bypass grafting: Insights from the Netherlands Heart Registration

## TL;DR

This study examines sex-related differences in coronary artery bypass grafting outcomes and strategies in the Netherlands, finding that women receive fewer arterial grafts but may benefit equally from multi-arterial grafting in younger populations.

## Contribution

The study provides new insights into sex disparities in coronary artery bypass grafting strategies and outcomes, particularly in younger patients.

## Key findings

- Female sex is independently associated with less multi-arterial grafting compared to men.
- Multi-arterial grafting reduces repeat revascularization in men but not in women.
- In younger patients, multi-arterial grafting eliminates survival differences between sexes.

## Abstract

Women are known to suffer from increased mortality and major adverse cardiac events rates after coronary artery bypass grafting compared to men. This study gives an overview of sex-disparities in grafting strategy and outcome of coronary artery bypass grafting in the Netherlands, and compares survival of the younger population undergoing multi-arterial grafting. Data were gathered retrospectively from the Netherlands Heart Registration database. Patients undergoing isolated after coronary artery bypass grafting were divided into groups treated with single or multi-arterial grafting. Using risk adjusted cox proportional hazard regression analysis, the effect of sex on the revascularization strategy and postoperative outcomes was assessed. Secondary analysis was conducted on a subset of patients aged 70 years or younger at baseline. The study included 51137 patients, of which 19.1% was female. When compared to men, women were older and suffered from more comorbidity. Female sex was independently associated with less multi-arterial grafting. While multi-arterial grafting led to a lower repeat revascularization rate in men (p = 0.022), this was not the case in women. Cox regression analysis did not independently associate the female sex with inferior survival. In the younger population, a survival benefit was observed after multi-arterial grafting, to the point where survival did not differ between sexes. Women receive fewer arterial grafts as opposed to men. In a younger patient population, the survival difference between sexes disappears when patients are treated with multi-arterial grafting.