In a contemporary setting, women continued to have worse outcomes than men after CABG.

Historically, women undergoing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) have had worse outcomes than men undergoing these procedures. With the advent of new medical therapies and procedural techniques, this gap may be narrowing. To find out, researchers analysed subgroup data from the global FAME 3 trial (NCT02100722), which randomised patients to fractional flow reserve (FFR)­-guided PCI or CABG for multivessel coronary artery disease.

Among 1500 patients (82% men; mean age, 65 years; 93% white), women were older than men and had more comorbidities and less­-complex coronary artery disease. At three years, the incidence of death, myocardial infarction (MI), stroke or repeat revascularisation (the primary endpoint) was similar in women and men (18% and 15%, respectively), as was the incidence of the secondary endpoint of death, MI or stroke (13% and 10%). After adjustment for baseline characteristics, women had a significantly higher risk for both end­ points compared with men (adjusted hazard ratios, 1.4 and 1.5), which was driven entirely by outcomes in those who underwent CABG. In women, outcomes at three years were similar with PCI or CABG; however, in men, outcomes were better with CABG than PCI, driven by more MIs and repeat revascularisations after PCI.

Comment: These data demonstrate a continued sex­based disparity in outcomes after CABG. Because women often have smaller coronary arteries, they often have fewer grafts performed (i.e. incomplete revascularisation) and are at increased risk for graft failure. It will be interesting to see whether further advances in surgical revascularisation can overcome this inherent anatomical challenge in women. In the meantime, I recommend that cardiologists take ample time to critically assess women’s coronary artery sizes and engage in frank dialogue with cardiothoracic surgery colleagues about which vessels are suitable grafts. This information can then be used to have better informed discussions with patients.

Shea E. Hogan, MD, MSCS, FACC, FSCAI, FSVM, Interventional Cardiologist, Denver Health; Associate Professor of Clinical Medicine, University of Colorado School of Medicine; Clinician-Scientist, CPC Clinical Research, Denver, USA.

Takahashi K, et al. Sex differences in patients undergoing FFR-guided PCI or CABG in the FAME 3 trial. JACC Cardiovasc Interv 2025; 18: 157-167.

This summary is taken from the following Journal Watch title: Cardiology.