Gender-Related Outcomes in Saphenous Vein Graft Interventions

Background: Saphenous vein graft percutaneous coronary intervention (SVG-PCI) is a relatively common procedure in patients after coronary artery bypass grafting (CABG). Although internal mammary artery is considered optimal, SVG is still used in the majority of patients.

Aims: Investigating the potential role of gender differences in the incidence and outcomes of SVG-PCI.

Methods: The study was based on a prospectively collected registry of 1199 consecutive patients (169 female) who underwent SVG-PCI in a tertiary medical center between 2004 and 2023. Primary outcomes included MACE (death, myocardial infarction [MI], target vessel revascularization [TVR], stroke) and mortality, at 1 and 3 years.

Results: Female patients were older (73.6 ± 9.1 years vs. 70.6 ± 9.7 years, p < 0.001), suffered from higher rates of diabetes mellitus, peripheral vascular disease, and congestive heart failure (78.1% vs. 61.3% p < 0.001, 13.6% vs. 7% p < 0.003, 66.3% vs. 51.8% p < 0.001 respectively). Additionally, female patients had lower trans-radial access use (11.9% vs. 19.3%, p < 0.025), and underwent SVG-PCI earlier following their CABG procedure (11.3 ± 6.2 years vs 12.9 ± 6.1 years, p < 0.003), as compared to male patients. There were no differences in MACE rates between the groups. Mortality was higher in the female group at 1 year (13.6% vs. 6.9%, p = 0.003), but no significant differences were observed at 3 years (24.3% vs. 20.9%, p = 0.320). Cox regression analysis identified age, renal function, ejection fraction, MI and trans-femoral as independent risk factors for mortality.

Conclusion: Gender-specific monitoring and early intervention, especially for women, are required for better management of graft patency, potentially improving long-term outcomes.