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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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