Original Research Sex Difference in Coronary Artery Bypass Grafting: Preoperative Profile and Early Outcome Joost F. ter Woorst, MD * , Albert H.M. van Straten, MD, PhD * , Saskia Houterman, PhD y , Mohamed A. Soliman-Hamad, MD, PhD * , 1 * Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, the Netherlands y Department of Education and Research, Catharina Hospital, Eindhoven, the Netherlands Objective: According to the available risk-stratification systems, women have a higher risk of mortality than men after coronary artery bypass grafting (CABG). In this study, the authors investigated the authors’ CABG database to trace factors contributing to this difference in outcome between sexes. Design: A retrospective patient record study. Setting: This single-center study was performed at the Catharina Hospital in Eindhoven, the Netherlands. Participants: The study comprised 17,919 patients, of whom 4,016 (22.4%) were women and 13,903 (77.6%) were men. Interventions: Coronary artery bypass grafting was performed between January 1998 and July 2016. Measurements and Main Results: Early mortality was significantly higher in women than in men (2.7% v 1.9%; p = 0.001). Regarding the base- line characteristics, women were older and had a lower hemoglobin level and a lower creatinine level than men. Women more often had hyper- tension, diabetes, underweight (body mass index [BMI] <20 kg/m 2 ), and obesity (BMI >30 kg/m 2 ). The mean number of grafts per patient was less in women than in men (3.2 § 1.1 v 3.5 § 1.1; p < 0.001). However, the mean cross-clamp time per graft was longer in female patients than in male patients (11.6 § 8.7 min. v 11.2 § 7.0 min.; p = 0.013). Logistic regression analyses showed that chronic obstructive pulmonary disease, peripheral vascular disease, cross-clamp time, and underweight were independent risk factors for early mortality only in men. Conclusion: The preoperative patient profile is significantly different between men and women undergoing CABG. The predictive value of well- known risk factors for early mortality is different between the 2 sexes. Ó 2019 Elsevier Inc. All rights reserved. Key Words: coronary artery bypass grafting; sex; early mortality FEMALE SEX IS an important risk factor for morbidity and mortality after coronary artery bypass grafting (CABG). 1 The European System for Cardiac Operative Risk Evaluation (EuroSCORE) 2 has been considered the predictive model of choice in Europe to estimate early mortality after cardiac sur- gery. In North America, however, the Society of Thoracic Sur- geons (STS) score is preferred 3 According to the EuroSCORE, female sex predicts higher mortality. However, other risk fac- tors included in the model weigh equally in both sexes. 2 Ear- lier reports 4 found that the EuroSCORE more accurately predicted mortality among female patients compared with the STS risk score. Despite the decrease in overall operative mor- tality in patients undergoing CABG over the previous decade, the higher risk of female sex has persisted. 58 Because women represent a growing population of patients undergoing cardiac surgery, it is important to understand the factors contributing to the higher mortality in the female population after CABG. 5 Women seem to be older when operated for coronary artery disease compared with men 9 and have more often hyperten- sion, diabetes, and a higher need for blood transfusion. 1013 1 Address reprint requests to Mohamed A. Soliman-Hamad, MD, PhD, Department of Cardiothoracic Surgery, Catharina Hospital, Michelangelolaan 2, Postbus 1350, 5602 ZA Eindhoven, the Netherlands. E-mail address: mohammed.soliman@catharinaziekenhuis.nl (M.A. Soliman-Hamad). https://doi.org/10.1053/j.jvca.2019.02.040 1053-0770/Ó 2019 Elsevier Inc. All rights reserved. ARTICLE IN PRESS Journal of Cardiothoracic and Vascular Anesthesia 000 (2019) 16 Contents lists available at ScienceDirect Journal of Cardiothoracic and Vascular Anesthesia journal homepage: www.jcvaonline.com