ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiovascular Surgery
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1641784
This article is part of the Research TopicUnveiling Sex Differences in Cardiology: Integrative Research and Clinical ImplicationsView all articles
Gender related outcome differences in off-pump coronary artery bypass grafting
Provisionally accepted
Riswan Akram1Friedrich Sobik2
Tim Knochenhauer2Sebastian A Philipp1Jens Brickwedel2Xiaoqin Hua3Beate Reiter2Svante Zipfel2Yvonne Schneeberger4
Evaldas Girdauskas5Hermann Reichenspurner2
Bjoern Sill2
Andreas Schaefer2*- 1Elbe Kliniken Stade, Stade, Germany
- 2University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- 3Universitatsklinikum Koln, Cologne, Germany
- 4Asklepios Kliniken GmbH & Co KGaA, Hamburg, Germany
- 5Universitatsklinikum Augsburg, Augsburg, Germany
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Objectives: Surgical myocardial revascularization shows impaired outcomes in women compared to men. Investigation of gender related outcome differences comprises of different operative strategies potentially hampering interpretation of data. We herein aimed to investigate gender related outcome differences in off-pump coronary artery bypass grafting (OPCAB) only.Methods: Between 2016 and 2021, 1075 consecutive patients underwent OPCAB at our center. Of those 880/1075 were male (81.9%) and 195/1075 were female (18.1%). Kaplan-Meier analysis was used for investigating differences in survival probabilities. Identification of risk factors was conducted by logistic regression.Results: Male patients showed a higher rate of reduced LVEF < 35% (88/880, 10% vs. 9/195, 4.61%; p=0.025) and impaired renal function (creatinine: 1.17 ± 0.76 vs. 1.03 ± 0.59; p=0.016).In female patients less utilization of both internal mammary arteries was documented (502/880, 57.04% vs. 74/195, 37.94%; p<0.001). Procedure time (256.13 min vs. 238.02 min; p<0.001) and number of distal anastomoses (2.40 ± 0.83 vs. 2.11 ± 0.82; p<0.001) were lower in female patients. 30-day mortality (16/880, 0.34% vs. 4/195, 0.51%; p=0.77) and rates of disabling stroke (3/880, 1.81% vs. 1/195, 2.05%; p=0.55) were similar between groups. In logistic regression analysis age (OR 1.079; CI 1.001-1.162; p=0.047) and impaired renal function (OR 1.495; CI 1.090 -2.051; p=0.013) were identified as independent risk factors for 30-day mortality.Conclusions: Male and female patients present similar 30-day outcomes after OPCAB suggesting a potential benefit of OPCAB in female patients. However, female patients receive more saphenous vein grafts compared to men, which may lead to impaired long-term outcomes.
Keywords: coronary artery bypass grafting, Coronary Artery Disease, gender, STEMI, NSTEMI, OPCAB
Received: 05 Jun 2025; Accepted: 22 Jul 2025.
Copyright: © 2025 Akram, Sobik, Knochenhauer, Philipp, Brickwedel, Hua, Reiter, Zipfel, Schneeberger, Girdauskas, Reichenspurner, Sill and Schaefer. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Andreas Schaefer, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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