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J Thorac Cardiovasc Surg 2003;126:620-622
© 2003 The American Association for Thoracic Surgery

Editorial

Sixty-year perspective on coronary artery bypass grafting in women

Renee S. Hartz, MDa,*, Julie A Swain, MDa,b, Lynda Mickleborough, MDb

a Department of Surgery, Tulane University Health Sciences Center, New Orleans, La, USA
b Toronto Hospital, Toronto, Ontario, Canada

Received for publication June 18, 2003; accepted for publication July 7, 2003.

* Address for reprints: Renee S. Hartz, MD, Department of Surgery, Tulane University Health Sciences Center, 1430 Tulane Ave, New Orleans, LA 70112-2699, USA
rhartz@tulane.edu

The first 20% of the full text of this article appears below.

The "60" in our title was designed to get the reader’s attention, since the first coronary artery bypass (CABG) procedure was performed less than 40 years ago. This editorial was written by three women cardiac surgeons, each of whom has practiced for 20 years, and it represents our 60-year cumulative experience. We are pleased to make a contribution to this timely editorial series and have highlighted key events in the history of recognition and treatment of coronary artery disease in women.

The eighties

Despite the fact that the systematic study of risk factors for coronary artery disease (CAD) had begun 30 years earlier (spearheaded by the Framingham Heart Study), CAD was still considered a disease of men. Early in this decade, the suspicion that women were referred for interventional therapies too seldom and too late led to the initiation of several retrospective reviews of referral and treatment patterns in women and men. At the same time the treatments were improving dramatically; there was an exponential increase in the performance of CABG, use of the internal thoracic artery as a bypass graft was becoming routine in many programs, and coronary angioplasty was rapidly evolving. The perception that women did worse after CABG was common, but few studies documented this fact.

In the Framingham Study, the diagnosis of CAD was based on the presence of chest pain. After receiving this diagnosis, significantly fewer women than men went on to have adverse cardiac events. However, the Coronary Artery Surgery Study (CASS), in which all patients underwent coronary angiography, showed that the prevalence of CAD in women with definite angina was 72%.1 Subsequent reanalysis of . . . [Full Text of this Article]






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