{"id":"7bc5059d489a","type":"article","url":"https://hartvaat.nl/2026/03/02/vrouwen-na-coronaire-bypasschirurgie-hoger-ziekenhuisrisico-en-minder-grafts-maa/","title":"Vrouwen na coronaire bypasschirurgie: hoger ziekenhuisrisico en minder grafts, maar vergelijkbare langetermijnoverleving","title_en":"Worse risk profile, number of grafts and hospital death but acceptable late survival in females undergoing coronary surgery: a 20-year propensity matched analysis","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["coronaire-bypass"],"journal":"Open Heart","doi":"http://openheart.bmj.com/cgi/content/short/13/1/e003894?rss=1","source_url":"https://doi.org/http://openheart.bmj.com/cgi/content/short/13/1/e003894?rss=1","authors":["Dixon","L. K.","Di Tommaso","E.","Gemelli","M.","Bruno","D. V.","Ascione","R."],"significance":6,"published":"2026-03-02","source_date":"2026-03-02","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/cabg-bypasschirurgie/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"This study examined sex differences in isolated coronary artery bypass grafting (CABG) over 20 years (2001-2021) at a single centre, with 1:1 propensity score matching (2,573 women vs 2,573 men). Women were older and more often had class III-IV angina, hypertension and diabetes. After matching, women received fewer left internal mammary artery (LIMA) grafts (84% vs 88%) and fewer total grafts (median 2 vs 3), had higher in-hospital mortality (2.2% vs 1.3%; OR 1.74) and longer hospital stays. Twenty-year survival, however, was similar. Off-pump CABG lowered in-hospital mortality in women (1.6% off-pump vs 3.0% on-pump). Women thus have higher perioperative risk and receive fewer (arterial) grafts, while long-term survival is equal — arguing for a female-tailored perioperative approach.","created":"2026-07-03T10:32:23Z","updated":"2026-07-03T13:31:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Deze studie onderzocht sekseverschillen bij geïsoleerde coronaire bypasschirurgie (CABG) over 20 jaar (2001-2021) in één centrum, met 1:1 propensity score-matching (2.573 vrouwen vs. 2.573 mannen). Vrouwen waren ouder en hadden vaker angina klasse III-IV, hypertensie en diabetes. Na matching kregen vrouwen minder vaak een linker-mammaria(LIMA)-graft (84% vs. 88%) en minder grafts in totaal (mediaan 2 vs. 3), hadden zij een hogere ziekenhuissterfte (2,2% vs. 1,3%; OR 1,74) en lagen zij langer in het ziekenhuis. De 20-jaarsoverleving was echter vergelijkbaar. Off-pump CABG verlaagde de ziekenhuissterfte bij vrouwen (1,6% off-pump vs. 3,0% on-pump). Vrouwen hebben dus een hoger peri-operatief risico en krijgen minder (arteriële) grafts, terwijl de overleving op lange termijn gelijk is — wat pleit voor een op vrouwen toegesneden peri-operatieve aanpak.","abstract_original":"<sec><st>Objective</st>\n<p>To evaluate sex differences in perioperative characteristics, in-hospital outcomes and long-term survival following coronary artery bypass grafting (CABG).</p>\n</sec>\n<sec><st>Methods</st>\n<p>Prospective data were collected for all patients undergoing isolated CABG at a single centre during 2001&ndash;2021. Baseline characteristics were adjusted between females and males using 1:1 propensity score matching (nearest-neighbour, without replacement). Kaplan-Meier analysis assessed long-term survival. A predefined sub-analysis assessed risk mitigation associated with using off-pump CABG (OPCABG) in females in the matched cohort.</p>\n</sec>\n<sec><st>Results</st>\n<p>Prematching, 11 563 males and 2573 females were included. Females were older with higher prevalences of class III&ndash;IV angina, hypertension and diabetes. After matching, 2573 patients per group were analysed, with standardised mean differences &lt;0.1 for all covariates. Females had fewer left internal mammary artery (LIMA) grafts (84% vs 88%, p&lt;0.001), fewer total grafts (median 2 vs 3, p&lt;0.001), higher in-hospital mortality (2.2% vs 1.3%, OR 1.74, 95% CI 1.14 to 2.71, p=0.011) and longer hospital stays (median 7 days vs 6 days, beta 0.51, 95% CI 0.12 to 0.90, p=0.01). Long-term survival was similar (stratified log-rank p=0.79). OPCABG mitigated the risk of in-hospital mortality in females (1.1% males vs 1.6% females, OR 0.69, 95% CI 0.33 to 1.43, p=0.32; 1.6% OPCABG females vs 3.0% on-pump females, OR 0.53, 95% CI 0.31 to 0.91, p=0.021).</p>\n</sec>\n<sec><st>Conclusions</st>\n<p>Females suffer higher in-hospital mortality and receive fewer LIMA and total number of grafts than males; however, 20-year survival is similar. OPCABG protects females from in-hospital mortality. A new female-tailored peri-operative care approach is warranted for females undergoing CABG.</p>\n</sec>"}