Coronary Artery Bypass Grafting in Women 50 Years or Younger

BACKGROUND: Prior research has shown higher mortality in women with severe coronary artery disease compared with men, particularly in younger patients. It is unknown if this could be attributable to an adverse risk factor profile. METHODS AND RESULTS: In a population‐based cohort study, we included all adults ≤50 years of age (932 women and 4514 men) who underwent coronary artery bypass grafting from 1995 to 2013 from the SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies) register. Following inverse probability of treatment weighting, we investigated differences between women and men. Women had a higher prevalence of cardiovascular risk factors compared with men. There was no difference in early mortality between women and men (unadjusted: 1.3% versus 0.9%; hazard ratio, 1.42; 95% CI, 0.75–2.70; weighted sample: 1.1% versus 1.0%; hazard ratio, 1.10; 95% CI, 0.52–2.30). During a median follow‐up time of 11.8 years, in the unweighted population, the risk of death was greater in women compared with men (hazard ratio, 1.34; 95% CI, 1.13–1.58). However, in the weighted sample, the risk of death was not significantly different in women compared with men (hazard ratio, 1.02; 95% CI, 0.83–1.26). CONCLUSIONS: Women ≤50 years of age had a higher unadjusted risk of death after coronary artery bypass grafting compared with men, but this was explained by a clustering of cardiovascular risk factors. Female sex per se was not associated with increased mortality or major adverse cardiovascular events. Early mortality was not increased in women compared with men, even though younger women in our study had an increased burden of risk factors known to affect early risk. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02276950.