Thursday, February 22, 2024

‘Women undergo less aggressive open heart surgery, experience worse outcomes than men’


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A new study has found that women are significantly less likely than men to undergo coronary artery bypass grafting (CABG) using guideline-recommended approaches, which may result in worse outcomes after surgery.
The results of the study were published in the journal ‘The Annals of Thoracic Surgery’. The study was presented at the 57th Annual Meeting of The Society of Thoracic Surgeons.
“This study highlights key differences between women and men in surgical techniques used for CABG and reveals opportunities to improve outcomes in women,” said Oliver K. Jawitz, MD, from Duke University in Durham, North Carolina.
Using the STS Adult Cardiac Surgery Database, which contains records of nearly all CABG procedures performed in the US, Dr Jawitz and colleagues from Duke and The Johns Hopkins University School of Medicine in Baltimore, Maryland, identified adult patients who underwent first-time isolated CABG from 2011 to 2019.
Researchers analysed detailed demographic, clinical, and procedural data from more than 1.2 million patients.
The correlation between female sex and three different CABG surgical techniques that are recommended in official US and European guidelines was examined closely.
According to Dr. Jawitz, all of these surgical approaches, grafting of the left internal mammary artery (LIMA) to the left anterior descending (LAD) artery, complete revascularization, and multiarterial grafting, have been associated with improved short and long-term outcomes. However, the results showed that women were 14 per cent -22 per cent less likely than men to undergo CABG procedures with these revascularization strategies.
“With these findings, we did in fact see less aggressive treatment strategies with women,” said Dr Jawitz.
“It is clear that sex disparities exist in all aspects of care for patients with coronary artery disease (CAD), including diagnosis, referral for treatment, and now, in surgical approaches to CABG. We must ensure that female patients undergoing CABG are receiving evidence-based, guideline-concordant techniques,” added Dr. Jawitz.
A cardiac surgeon who was not affiliated with the study said that the sheer volume of patient records analysed is meaningful.
“This was an important study, especially since it utilized the world’s largest cardiac surgical database to document a difference in surgical strategies between men and women who underwent coronary bypass surgery, said Robbin G Cohen, MD, MMM, from Keck School of Medicine of the University of Southern California in Los Angeles.
“Now we need to understand the reasons for this disparity and the implications for both short- and long-term results,” added G Cohen.
While multifactorial, the undertreatment of CAD in women largely stems from a failure to recognise key differences in cardiovascular risk factors and symptoms in females compared with males, explained Dr Jawitz.
Women are much more likely to experience atypical, subtler symptoms of heart disease such as fatigue, abdominal pain, nausea, vomiting, indigestion, and back pain. Sometimes, women do not even feel the obvious chest pain and pressure that are characteristic of CAD. As far as risk factors, women have their own unique set, including relatively high testosterone levels prior to menopause, increased hypertension during menopause, and higher levels of stress and depression. (ANI)


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