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J Thorac Cardiovasc Surg 2003;126:929-931
© 2003 The American Association for Thoracic Surgery

Editorial

Is what's good for the gander good for the goose?

Nanette K. Wenger, MD*

Professor of Medicine (Cardiology), Emory University School of Medicine; Chief of Cardiology, Grady Memorial Hospital; Consultant, Emory Heart & Vascular Center, Atlanta, Ga

Received for publication May 7, 2003; accepted for publication June 3, 2003.

* Address for reprints: Nanette K. Wenger, MD, Emory University School of Medicine; 69 Jesse Hill Jr Dr, SE, Atlanta, GA 30303, USA
nwenger@emory.edu

The first 300 words of the full text of this article appear below.


Editorial Note: The gender initiative, a provocative series on gender differences in the surgical treatment of cardiac, vascular, and thoracic disease, continues this month with editorials on coronary revascularization in women.

A foremost expert in gender-specific risks and outcomes, Nanette K. Wenger, MD, summarizes the best available data, progress to date, and remaining questions for women undergoing coronary revascularization. Another group summarizes the statistical problems that may confound studies of gender differences. Finally, cardiac surgeons contemplate possible differences in the technical aspects of coronary artery bypass grafting. The series continues in December with editorials on coronary artery surgery and recovery.

Nancy A. Nussmeier, MDTexas Heart Institute

See related editorials on pages 932, 936, 950, and 959.

 

Coronary heart disease is the leading cause of death for women in the United States, accounting for almost 250,000 deaths annually. Since 1984 more US women than men have died each year of cardiovascular disease. Emerging data have reinforced sex-related differences in responses to therapies, including adverse responses. This editorial highlights the excess mortality of coronary artery bypass graft (CABG) surgery in women, addressing the need to derive more detailed sex-specific information that has the potential to improve clinical outcomes. Owing to the paucity of randomized trial data for women, the material presented derives primarily from databases, registries, and case series.

What we know

Rates of performance of CABG surgery in the Coronary Artery Surgery Study (CASS) Registry, when adjusted for clinical and angiographic characteristics, were comparable for women and men. There were few sex differences in long-term survival, differing only by the variance in operative mortality, 5.3% for women versus 2.5% for men.1 Details of the operative mortality characteristics are not presented. Can they be derived from this data set? If not, would systematic medical record review of fatalities be feasible? As in other settings, conventional . . . [Full Text of this Article]






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Copyright © 2003 by The American Association for Thoracic Surgery.