We prospectively studied, for 1 year initially, 353 consecutive patients (297 male 56 female, 57.2 +/- 7.32 years) with chronic stable angina admitted for coronary artery bypass graft (CABG) surgery in the North East of England. Patients generally had severe anginal symptoms (median 36 months duration) despite anti-anginal therapy (90% taking two or more anti-anginal drugs). Women were more severely symptomatic than men prior to surgery, despite a similar severity of angiographically-defined coronary artery disease, suggesting possible referral bias. Women were given fewer grafts than men in operations carrying similar risks. After surgery, clinical outcome was generally good but women had a higher mortality (12-month mortality 14% in women vs. 6% in men), and higher morbidity in terms of readmissions, angina symptoms, antianginal drug use and effort tolerance. This series describes clinical practice in an area of high coronary disease morbidity and mortality. It identifies the real risks for women with severe symptomatic disease undergoing coronary artery surgery. We believe it highlights the need for improved risk stratification in the treatment of women with angina, and a consideration of alternative treatment strategies for those women destined to have a poor outcome from CABG.