Early occlusion after CABG much more likely for female patients
Women face a significantly higher risk of early occlusion after isolated coronary artery bypass graft (CABG) surgery than men, according to new findings published in The Annals of Thoracic Surgery.[1]
The study’s authors reviewed imaging data from nearly 600 patients who underwent isolated CABG at a single facility from 2020 to 2025. The mean patient age was 67 years old. Women made up 16% of the study.
While many patient characteristics were similar between men and women, the group did find that women tended to be older and presented with a higher mean EuroSCORE II than men. Also, women were less likely to receive a distal anastomosis and more likely to receive a venous graft.
Overall, early bypass graft occlusion was detected in 7.6% of all CABG patients, 6.5% of men and 13.7% of women. While a vast majority of bypass graft occlusions were “clinically silent,” four women and two men did present with severe enough symptoms that coronary angiography was performed. These patients all either underwent percutaneous coronary intervention or redo CABG prior to discharge.
In general, perioperative data for patients with and without occluded grafts were comparable. However, the authors noted, patients with occluded grafts were linked to longer operation times and prolonged hospital stays.
Approximately 50% of the patients enrolled in this analysis were followed for at least one year, and the median follow-up duration was 15 months. Approximately 8% of patients did experience an early occlusion, including 20 men and five women. Rehospitalization and reinterventions were both much more common for the early occlusion patients, highlighting the potential long-term impact early occlusion may have on other clinical outcomes.
Death-free survival, meanwhile, was comparable for men and women as well as the early occlusion and no early occlusion patient groups.
“The higher incidence of occlusion in female patients appears to be multifactorial and may include demographic differences, as women in our cohort undergoing CABG surgery were older and more frequently had extracardiac arteriopathy and previous cerebrovascular events,” wrote co-first authors Luca Koechlin, MD, and Islam Salikhanov, MD, PhD, with the department of cardiac surgery at University Hospital Basel in Switzerland, and colleagues. “Furthermore, women may have smaller coronary arteries and more complex coronary artery disease … and therefore undergo technically more challenging procedures; however, these factors remain speculative.”
The group also noted that these data were in line with previous clinical trials comparing CABG outcomes among men and women.
“While most studies highlighting these differences have been retrospective and thus only hypothesis-generating, future research should focus on the underlying pathophysiological mechanisms responsible for these disparities,” the authors explained. “Whether the sex-specific differences in occlusion rates can be reduced by adapting operative strategies or postoperative treatment remains to be evaluated in future studies. Furthermore, in daily clinical practice, clinicians should be aware of the higher occlusion rate in female patients and maintain a high level of suspicion when assessing them postoperatively.”
Finally, the group wondered if postoperative CT assessments should be standardized to ensure all signs of early occlusion are identified. This could lead to greater costs for healthcare systems, they said, but it is an idea they believe “warrants further investigation.”
There were certain limitations to this analysis, including the fact that it only included patients treated at a single facility. The study was also associated with certain strengths, including the fact that it helped highlight the potential benefits of using CT images to examine patient outcomes following CABG.
Click here to read the full analysis.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.