Women with severe coronary artery disease may experience better long-term outcomes from coronary artery bypass grafting (CABG) than from stenting, according to a recent study by researchers at Weill Cornell Medicine. The findings were published on November 25 in the European Heart Journal.
The study addresses a gap in clinical evidence for women with heart disease, as they have historically represented only about 20% to 25% of large trials comparing bypass surgery and stenting. Coronary artery disease is the leading cause of death among women, but their unique symptoms and later onset often result in delayed diagnoses.
Researchers collaborated with the University of Toronto to review data from all women under age 80 in Ontario, Canada, who had extensive high-risk artery blockages and underwent either stenting or bypass surgery between 2012 and 2021. The analysis included an average follow-up period of five years for each patient, focusing on a subset of 4,066 women matched by characteristics to simulate a randomized trial.
"We were very fortunate to have access to this unique dataset," said Dr. Kevin An, lead author and clinical fellow at NewYork-Presbyterian/Columbia University Irving Medical Center. "It allowed us to look at a large number of women with severe coronary artery disease in a real-world setting and follow their long-term outcomes."
Results showed that approximately 36% of women who received stents experienced major cardiovascular events such as heart attack, stroke, repeat revascularization procedures, or hospital readmission for heart conditions or stroke. In contrast, only 22% of those who underwent bypass surgery faced similar events. Additionally, the risk of death from any cause was about 30% higher among those who had stenting compared to those who had bypass surgery during the entire follow-up period. However, mortality risks were similar between both groups during the first six months after treatment.
"Over the long term, bypass surgery seems to be more protective compared to stenting," Dr. An stated. He noted one exception: women treated with stents had a slightly lower risk of stroke than those who received bypass surgery.
Dr. An also pointed out that "currently, women are about half as likely to undergo bypass surgery as men." Dr. Mario Gaudino added that more comprehensive data are needed before changing practice guidelines and mentioned ongoing research aimed at addressing this evidence gap.
"For now, treatment decisions should remain individualized," said Dr. An. "Although our study suggests that bypass surgery may offer more long-term protection compared to stents, anatomical considerations, individual surgical risk, and patient preferences remain critical."
