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The Journal of Thoracic and Cardiovascular Surgery, Vol 84, 334-341, Copyright © 1982 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
LD Fisher, JW Kennedy, KB Davis, C Maynard, JK Fritz, G Kaiser and WO Myers
The Collaborative Study in Coronary Artery Surgery (CASS) is a large
multi-institutional study of the medical and surgical treatment of coronary
artery disease. Fifteen cooperative institutions have carried out isolated
coronary artery bypass grafting (CABG) on 6,258 men and 1,153 women during
the period August, 1975, through May, 1980. The operative mortality in men
was 1.9%, while the operative mortality for women undergoing CABG in the
same institutions during the same time period was 4.5%. In an effort to
explain this result, we used multivariate analysis to identify factors
associated with increased mortality in women after CABG. The hypothesis
that smaller physical size might be contributing to increased mortality was
considered. Basic clinical and angiographic variables, size variables,
including the average diameter of the grafted vessels, and gender were
examined separately for patients who underwent elective and urgent and
emergency procedures. Using multivariate information theory, we found that
the most information regarding survival after operation is contained in
basic clinical and angiographic variables. The physical size of the
patient, including coronary artery diameter, helps predict operative
mortality even after adjusting for differences in risk predicted by the
basic variables and gender. However, the patient's sex is not statistically
significantly related to the risk of surgical death given the information
available from clinical and angiographic variables and from knowledge of
patient size. One possible explanation of the excess risk for coronary
artery operations in women is the smaller stature and the smaller diameter
of the coronary arteries in this group of patients.
ARTICLES
Association of sex, physical size, and operative mortality after coronary artery bypass in the Coronary Artery Surgery Study (CASS)
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J. S. Carey, R. A. Cukingnan, and L. K. M. Singer Health Status After Myocardial Revascularization: Inferior Results in Women Ann. Thorac. Surg., January 1, 1995; 59(1): 112 - 117. [Abstract] [Full Text]
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 F. E. Kuhn and C. E. Rackley Coronary Artery Disease in Women: Risk Factors, Evaluation, Treatment, and Prevention Arch Intern Med, December 13, 1993; 153(23): 2626 - 2636. [Abstract] [PDF]
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 N. K. Wenger, L. Speroff, and B. Packard Cardiovascular Health and Disease in Women N. Engl. J. Med., July 22, 1993; 329(4): 247 - 256. [Full Text]
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M. R. Bell, D. R. Holmes Jr, P. B. Berger, K. N. Garratt, K. R. Bailey, and B. J. Gersh The Changing In-Hospital Mortality of Women Undergoing Percutaneous Transluminal Coronary Angioplasty JAMA, April 28, 1993; 269(16): 2091 - 2095. [Abstract] [PDF]
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 J. Herman Gender Differences in Coronary Artery Disease: Bias, Method, or Fact of Life? Arch Fam Med, April 1, 1993; 2(4): 365 - 366. [Abstract] [PDF]
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E. P. Steinberg Magnetic Resonance Coronary Angiography -- Assessing an Emerging Technology N. Engl. J. Med., March 25, 1993; 328(12): 879 - 880. [Full Text]
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Y. Liao, R. S. Cooper, J. K. Ghali, and A. Szocka Survival Rates With Coronary Artery Disease for Black Women Compared With Black Men JAMA, October 14, 1992; 268(14): 1867 - 1871. [Abstract] [PDF]
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S. B. Eysmann and P. S. Douglas Reperfusion and Revascularization Strategies for Coronary Artery Disease in Women JAMA, October 14, 1992; 268(14): 1903 - 1907. [Abstract] [PDF]
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 H. M. Krumholz, P. S. Douglas, M. S. Lauer, and R. C. Pasternak Selection of Patients for Coronary Angiography and Coronary Revascularization Early after Myocardial Infarction: Is There Evidence for a Gender Bias? Ann Intern Med, May 15, 1992; 116(10): 785 - 790. [Abstract] [PDF]
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N. A. Bickell, K. S. Pieper, K. L. Lee, D. B. Mark, D. D. Glower, D. B. Pryor, and R. M. Califf Referral Patterns for Coronary Artery Disease Treatment: Gender Bias or Good Clinical Judgment? Ann Intern Med, May 15, 1992; 116(10): 791 - 797. [Abstract] [PDF]
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W. K. Laskey Gender Differences in the Management of Coronary Artery Disease: Bias or Good Clinical Judgment? Ann Intern Med, May 15, 1992; 116(10): 869 - 871. [Abstract] [PDF]
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C. Maynard, P. E. Litwin, J. S. Martin, and W. D. Weaver Gender Differences in the Treatment and Outcome of Acute Myocardial Infarction: Results From the Myocardial Infarction Triage and Intervention Registry Arch Intern Med, May 1, 1992; 152(5): 972 - 976. [Abstract] [PDF]
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O. N. Nwasokwa, J. H. Koss, G. H. Friedman, A. M. Grunwald, and M. M. Bodenheimer Bypass Surgery for Chronic Stable Angina: Predictors of Survival Benefit and Strategy for Patient Selection Ann Intern Med, June 1, 1991; 114(12): 1035 - 1049. [Abstract] [PDF]
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 J. R Utley, S. A Leyland, H. D Johnson, M. S Morgan, C. M Wilde, M. S Bell, M. M Sawaf, and B. S Harrison Correlation of preoperative factors, severity of disease, type of oxygenator and perfusion times with mortality and morbidity of coronary bypass Perfusion, January 1, 1991; 6(1): 15 - 22. [Abstract] [PDF]
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W.P. Chan, B. Bharadwaj, and K. Prasad Effects of Diltiazem on the Functional Recovery of the Myocardium at Organ and Cellular Level During Prolonged Hypothermic Ischemic Cardiac Arrest Angiology, September 1, 1990; 41(9): 702 - 714. [Abstract] [PDF]
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N. K. Wenger Gender, Coronary Artery Disease, and Coronary Bypass Surgery Ann Intern Med, April 15, 1990; 112(8): 557 - 558. [Abstract] [PDF]
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S. S. Khan, S. Nessim, R. Gray, L. S. Czer, A. Chaux, and J. Matloff Increased Mortality of Women in Coronary Artery Bypass Surgery: Evidence for Referral Bias Ann Intern Med, April 15, 1990; 112(8): 561 - 567. [Abstract] [PDF]
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J. N. TOBIN, S. WASSERTHEIL-SMOLLER, J. P. WEXLER, R. M. STEINGART, N. BUDNER, L. LENSE, and J. WACHSPRESS Sex Bias in Considering Coronary Bypass Surgery Ann Intern Med, July 1, 1987; 107(1): 19 - 25. [Abstract] [PDF]
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V. Vaccarino, J. L. Abramson, E. Veledar, and W. S. Weintraub Sex Differences in Hospital Mortality After Coronary Artery Bypass Surgery: Evidence for a Higher Mortality in Younger Women Circulation, March 12, 2002; 105(10): 1176 - 1181. [Abstract] [Full Text] [PDF]
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