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J Thorac Cardiovasc Surg 2003;126:1707-1711
© 2003 The American Association for Thoracic Surgery

Editorial

Long-term benefits of coronary bypass surgery: Are the gains for women less than for men?

^a Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Ga, USA
^b Cleveland Clinic Foundation, Department of Cardiothoracic Anesthesia, Cleveland, Ohio, USA

Received for publication September 16, 2003; accepted for publication October 7, 2003.

^* Address for reprints: Viola Vaccarino, MD, PhD, Department of Medicine, Division of Cardiology, Emory University School of Medicine, 1256 Briarcliff Rd, Suite 1 N, Atlanta, GA 30306, USA
lvaccar@emory.edu

The first 300 words of the full text of this article appear below.

The issue of whether there are disparities in the outcome of coronary revascularization between women and men, in particular coronary artery bypass graft (CABG) surgery, has been the object of intense debate in the past 10 to 15 years. Studies have disagreed on whether the risks and benefits resulting from CABG surgery differ between women and men. Indeed, few areas of clinical research have been more controversial than this. Overall, clinicians are left with the suspicion that CABG poses special risks in women or is less effective in this group. This fact may discourage prompt referral of women for CABG and lead to gender-related disparities in referral, another area of major debate.^1,2 In turn, a later referral for CABG may contribute to higher operative risk and fewer long-term benefits if women are referred when their disease is more advanced and/or their comorbidity burden worse. Therefore, it is necessary to come soon to a consensus on whether CABG surgery is a beneficial procedure in women, at least to the same extent as it is in men.

A major reason why this question is very difficult to resolve is that major randomized trials of the efficacy of CABG surgery compared with medical therapy have been conducted almost exclusively in men.³ Most of the trials comparing CABG with percutaneous transluminal coronary angioplasty also have focused on men.⁴ Currently, more than 150,000 CABG procedures per year are performed in women in the United States, or almost one third of the total,⁵ and the number of CABG procedures performed on women is rapidly increasing, in part due to the gradual aging of the surgical population.^6,7 However, there is no clinical trial evidence supporting the efficacy of this procedure in women. Since CABG has become, nonetheless, part of the standard of care for the treatment of . . . [Full Text of this Article]

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