Although long-term outcomes with CABG in women are similar to or even better than those in men, women have higher rates of periprocedural morbidity and mortality.1133 1139 Several hypotheses have been suggested to explain this increased morbidity and mortality, including older age at presentation, more frequent need for urgent revascularization, more comorbid conditions, smaller body surface area and coronary arterial dimensions, and increased risk of bleeding. The fact that women on average are older than men at the time of CABG is thought, at least in part, to be due to the loss of the protective effects of estrogen with menopause.1134,1138,1140 1148 In studies of age-matched men and women undergoing CABG, in-hospital mortality rates were similar, even among the elderly ( 70 years of age).1149,1150 In addition to being older, women undergoing CABG are more likely than men to have ACS and cardiogenic shock1140 and, therefore, to require urgent revascularization.1138,1141 1143,1146,1148 Sex disparity in the diagnosis and treatment of CAD may contribute to the more complex and delayed presentations in women compared with men.1151 In comparison to men, women are less likely to be referred for coronary angiography and revascularization and are more likely to have refractory ischemia and repeated hospitalizations.1152 Compared with men undergoing CABG, women have more comorbid conditions, including diabetes mellitus, hy- pertension, hyperlipidemia, chronic renal insufficiency, chronic obstructive pulmonary disease, and concomitant val- vular disease.1153 In some studies, no significant difference in outcomes between women and men undergoing CABG was noted when the data were adjusted for age and comorbidi- ties,1136 1138,1154 1156 whereas in others, female sex remained an independent predictor of a worse outcome.1141,1157,1158 In a systematic review of sex differences and mortality after CABG, early mortality differences were reduced but not eliminated after adjustment for comorbidities, procedural characteristics, and body habitus.1139 Some investigators have shown that smaller body surface area, a surrogate for coro- nary arterial size, is associated with higher risk of perioper- ative mortality, whereas others have not.1140 Women use more hospital resources in the perioperative period than do men, including intra-aortic balloon counter- pulsation,1137 vasopressors, mechanical ventilation, dialysis, and blood products,1154,1159 all of which are associated with higher mortality rates.1146,1160,1161 Women are more likely to have wound complications and longer ICU and hospital stays.1162 1165 Lastly, the operative procedure itself appears to be different in women than in men, in that women are less likely to be completely revascularized1166,1167 and less likely to have IMA grafting, especially bilateral,1168 although bilat- eral IMA grafting in women is associated with low rates of in-hospital morbidity and mortality.1169 6.3. 