Arq. Bras. Cardiol. 2025; 122(5): e20250323
Nothing about Women without Women is for Women
Camila Perez de Souza Arthur
, Omar Asdrúbal Vilca Mejia
This Short Editorial is referred by the Research article "Is Female Gender Associated with Mortality in Coronary Artery Bypass Grafting?".
Adjusted analyses show that women have higher mortality rates than men after coronary artery bypass grafting (CABG), in addition to receiving a lower-quality surgical technique., Current strategies focus on preoperative optimization and standardization of intra- and postoperative care, as well as including more women in research. Currently, women are underrepresented, reaching up to 16% of the sample in some trials. This reinforces the call for greater equity and greater inclusion of women in research projects, or, on the contrary, for specific studies on women. I believe that we have been slow to reflect on this reality, since female gender has been considered a predictor of mortality in CABG since the publication of CASS in 1981 and has remained constant, including in our setting as part of InsCor. This was once again recognized in this important article by Goncharov et al. Identifying female sex as a predictor of mortality in a single-center and retrospective study with 9,845 patients, where less than 20% were women. However, unlike other studies, the difference in mortality between women and men was lost after pairing.
The propensity score adjusts an analysis based on the observed variables, while randomized studies balance both known and unknown variables. Bias arises when differences in results may be a consequence of secondary characteristics of the patients, and this can be noticeable in a sample spanning almost 3 decades. Within this, perhaps the variable that may have most influenced these results was the inclusion of surgeries combined with CABG and not just CABG alone. Women in general are operated on with more comorbidities and arrive at a more advanced stage for surgery.
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