CHICAGO (January 30, 2021) – Women are significantly more likely than men to undergo coronary artery bypass grafting (CABG) using guided-recommended procedures, which may lead to more effective results. worse after surgery, according to a scientific presentation at the 57th AGM. Society of Thoracic Surgeons.
“This study highlights key differences between women and men in surgical techniques used for CABG and highlights 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 almost all CABG procedures performed in the US – Dr. Jawitz and colleagues from Duke and Johns Hopkins University School of Medicine in Baltimore, Maryland, identified adult patients who underwent solitary CABG for the first time from 2011 to 2019. Researchers analyzed demographic, clinical, and clinical data. detailed procedures from more than 1.2 million patients.
The link between female gender and three different CABG surgical modalities recommended in official US and European guidelines has been closely studied. According to Dr. Jawitz, all of these surgical procedures – grafting of the internal mammary artery (LIMA) to the anterior left artery (LAD), complete resection, and multiarterial grafting – are performed. be associated with short-term development and / or long-term outcomes. However, the results showed that women were 14% –22% more likely than men to undergo CABG procedures with these recovery strategies.
“With those decisions, we actually saw less aggressive treatment strategies with women,” Dr. Jawitz said. “It is clear that there are gender differences in all aspects of care for patients with coronary artery disease (CAD), including diagnosis, referral for treatment, and now, in surgical procedures to CABG. We need to ensure that female patients receiving CABG have access to evidence – based, coherent approaches. ”
A heart surgeon unrelated to the study said the number of patient records examined was significant. “This was an important study, especially as it used the world’s largest cardiac surgery database to record differences in surgical strategies between men and women who have undergone postoperative surgery. coronary pathway, said Robbin G. Cohen, MD, MMM, of the Keck School of Medicine of the University of Southern California at Los Angeles. “Now we need the reasons for this difference and the consequences for both outcomes. understand short-term and long-term. ”
Although multifactorial, CAD uptake in women largely stems from the recognition of major differences in cardiovascular risk factors and symptoms in women compared to men, Dr. Jawitz explained.
Women are much more likely to experience unusual, more relaxed symptoms of heart disease such as fatigue, abdominal pain, nausea, vomiting, indigestion, and back pain. At times, women do not even feel the obvious pain and pressure that is normal in CAD. In terms of risk factors, women have their own particular set, including relatively high testosterone levels before menopause, increased hip tolerance during menopause, and higher levels of stress and depression.
Another challenge has been that women’s health has historically focused largely on maternal and child issues, as well as early diagnosis and treatment of breast cancer. These discussions need to include a stronger emphasis on cardiovascular risk factors and interventions, which are critical to successfully addressing the leading cause of death for women in the U.S. – heart disease, according to Dr. Jawitz.
In addition, women typically have a longer time from onset to diagnosis and from diagnosis to medical intervention. Each of these delays will allow the disease to worsen over time, increasing the risk for adverse surgical outcomes. And when women are finally referred for bypass surgery, they are still at a disadvantage, as they often do not receive CABG with LIMA to LAD, complete resuscitation, or multifactorial grafting. – they are all related to improved outcomes.
“Delayed delay of CAD in women leads to delayed onset of major behavioral and pharmacologic interventions for reducing the risk of heart disease, as well as delayed delay for diagnostic procedures and invasive treatment, which introducing surgical resuscitation with CABG, “said Dr. Jawitz. “This often means that, before female patients undergo these procedures, they have a more serious disease than the males, as well as a greater number of comorbidities, which leads to worse outcomes.”
In some clinical trials, women are still underrepresented. According to an unrelated study of research data, less than 40% of all enrolled in cardiovascular clinical trials from 2010 to 2017 were women. Lack of knowledge is often cited as a reason for these persistent differences.
“The available evidence for different therapies and interventions is unequivocally based on male cardiovascular biology,” Dr. Jawitz said. “But as research in this area grows stronger, data will continue to emerge showing that cardiovascular disease manifests differently by gender. Awareness-raising goes a long way between reduce gender disparities in CAD results. “
Moving forward, guidelines need to be developed that reflect the significant differences between men and women in CAD publication, which will certainly require greater representation of female patients in clinical trials of cardiovascular therapies. , explained Dr. Jawitz.
“Now that we have identified significant differences in surgical procedures to CABG between women and men, we need to further explain how these differences lead to different outcomes. such as increased mortality, recurrence, and complications, “he said.” These findings will help inform the development of specific gender guidelines for the detection and management of cardiovascular disease. “
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For more information, contact STS Senior Media Relations Manager Jennifer Bagley at 312-202-5865 or [email protected].
Founded in 1964, the Society of Thoracic Surgeons is a non-profit organization representing more than 7,500 cardiothoracic surgeons, researchers, and allied health care professionals worldwide dedicated to ensuring the optimal results for surgeries of the heart, lungs, and esophagus, as well as other surgical procedures within the breast. The mission of the Society is to advance the delivery of cardiothoracic surgeons of the highest quality patient care through collaboration, education, research and advocacy.