Abstract
Cardiovascular disease remains the leading global cause of death, with coronary artery bypass grafting (CABG) serving as the gold standard for managing complex coronary artery disease. Despite advancements in surgical techniques and perioperative care, women undergoing CABG continue to face poorer outcomes compared to men, including higher operative and long-term mortality, greater rates of graft failure, and an increased incidence of postoperative complications such as stroke and sternal wound infections. Women also exhibit higher readmission rates, worse recovery trajectories, and lower quality of life after surgery. The underlying factors contributing to these disparities are multifactorial. Women typically present with advanced age, a higher burden of cardiovascular risk factors, and smaller coronary artery and graft diameters, all of which pose technical challenges and may reduce graft patency. Additionally, socioeconomic barriers, delayed diagnoses due to atypical symptom presentation, and lower utilization of evidence-based secondary prevention strategies widen the outcome gap. Efforts to address these disparities must include greater representation of women in clinical trials, as well as designing trials dedicated to women, as emphasized by the Randomized Comparison of the Clinical Outcome of Single vs Multiple Arterial Grafts: Women (ROMA: Women) and Revascularization Choices Among Under-Represented Groups Evaluation (RECHARGE) trials. Future strategies should prioritize personalized cardiac care, optimize surgical approaches tailored to sex-specific anatomy, and strengthen secondary prevention adherence in women.