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Ann Thorac Surg 1998;66:125-131
© 1998 The Society of Thoracic Surgeons
a Division of Cardiothoracic Surgery, University of Florida Health Science Center, Jacksonville, Florida, USA
b Department of Surgery, Torrance Memorial Medical Center, Torrance, California, USA
c University of Colorado Health Science Center, Denver, Colorado, USA
d Summit Medical Systems, Minneapolis, Minnesota, USA; and Department of Surgery
e Tulane Medical School, New Orleans, Louisiana, USA
Accepted for publication February 27, 1998.
Address reprint requests to Dr Edwards, Division of Cardiothoracic Surgery, University of Florida Health Science Center, 653-2 W Eighth St, Jacksonville, FL 32209-6511
e-mail: (fhe{at}mediaone.net)
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Abstract |
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 Top Abstract IntroductionMaterial and methodsResultsCommentAppendix 1References |
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Methods. The Society of Thoracic Surgeons National Cardiac Surgery Database was used to retrospectively examine 344,913 patients undergoing coronary artery bypass graft operations from 1994 through the most recent data harvest. The operative mortality of male and female patients was compared for a variety of single risk factors and combinations of risk factors. A logistic risk model was used to account for all important patient parameters so that individuals could be stratified into comparable categories allowing for direct comparisons of risk-matched male and female patients.
Results. The univariate analysis showed that the 97,153 women carried a significantly higher mortality for each of the risk factors examined. The multivariate analysis and the risk model stratification showed that women had significantly higher mortality as compared to equally matched men in the low- and medium-risk part of the spectrum, but in high-risk patients, there was no difference between male and female mortality.
Conclusions. Gender is an independent predictor of operative mortality except for patients in very high-risk categories.
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Introduction |
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TopAbstractIntroductionMaterial and methodsResultsCommentAppendix 1References |
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The Society of Thoracic Surgeons National Cardiac Surgery Database, commonly called the STS Database, provides a unique substrate for detailed examination of this compelling issue. This report will analyze the recent national CABG surgical experience to determine whether a difference in operative mortality truly exists. Specifically, the purpose of this study is to answer the following question: All other factors being equal, is there a significant difference in operative mortality between men and women undergoing CABG?
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Material and methods |
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TopAbstractIntroductionMaterial and methodsResultsCommentAppendix 1References |
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These patient records were extracted for analysis using standard statistical software (Statistical Analysis System [SAS] version 6.09 for Windows; SAS Institute, Cary, NC). All p values were determined using 
2 tests with the appropriate degrees of freedom. Specific risk factors were selected as described in previous reports [6]. The definition of these risk factors conforms to standard published guidelines [13].
Logistic risk models of CABG operative mortality were derived and applied in the manner previously reported [6]. Details of this model, including specific risk factors and validation techniques, are fully described elsewhere [6]. The most current risk model, which is based on 1994 data, was used to determine the net impact of all important risk factors to stratify male and female patients into appropriate risk categories. To prevent the model from considering gender bias in the stratification process, the risk factor associated with gender was arbitrarily excluded in model derivation (Appendix 1).
Initially the male and female populations were compared to determine differences in overall patient presentation (Tables 1, 2). Risk stratification was then performed to compare the operative mortality (OM) of subpopulations having similar risk. This risk stratification was conducted in three levels. Table 3 shows the comparative OM for individual risk factors of clinical importance. To further refine the stratification, combinations of risk factors were selected for comparison (Table 4). Finally, to fully account for the impact of all significant risk factors, the STS risk model was used to place patients into groups of similar risk. The use of risk models in this context is particularly meaningful. Because of the importance of this part of the analysis, the population was stratified in two independent ways. Table 5 breaks down the population by generally accepted subgroups of clinical importance. In Table 6, the population was arranged in sequential order of predicted mortality and then divided into 10 groups having equal numbers of deaths [14].
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Results |
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TopAbstractIntroductionMaterial and methodsResultsCommentAppendix 1References |
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A comparison of risk factors for men and women (Table 2) shows that there were significant differences in the two populations. In general, women were older, had a higher incidence of diabetes, hypertension, and peripheral vascular disease, and underwent nonelective procedures more often. On the other hand, men were more likely to have poor ventricular function, a significant smoking history, and the need for reoperation.
Risk factor comparisons
Table 3 shows the comparative OM for each risk factor of clinical importance. As shown in this table, the OM was significantly higher for women in every risk category.
Risk factors grouped by different combinations of age, surgical priority, and operative incidence are presented in Table 4. The OM was significantly higher for women in all categories except for elderly patients undergoing "redo" procedures.
Risk model comparisons
Whereas the three factors used in Table 4 are quite important, there certainly are other risk factors of clinical significance. To account for the impact of all major risk factors, the STS risk models of OM were used. Table 5 compares subgroups selected by commonly used clinical groupings. Women were found to have significantly higher mortality rates except in the highest risk categories. When patients were arranged into deciles having equal numbers of deaths (Table 6), there again was a significant difference in mortality except in the highest risk category.
Body surface area comparisons
Because of the central importance of body surface area (BSA) in this issue, we focused specifically on its influence. Body surface area did emerge as one of the significant risk factors for inclusion into the risk model and was associated with a beta value of -0.7075 (Appendix 1), its negative value indicating that risk decreases with increasing BSA. To examine its influence in more detail, the OM for women was compared with that of males having similar BSA. All patient records were sequentially arranged according to recorded BSA and then broken down into 10 groups having the same number of records. Operative mortality for women was then compared with that of men for each decile (Table 7). As shown in Figure 1, the difference in OM between men and women is more accentuated at higher BSA. It is particularly important to note that there was no difference in mortality for those patients in the smallest BSA groups (BSA < 1.805 m2). This is consistent with previous findings showing that when BSA is normalized, there is no difference in CABG operative mortality. In the higher ranges of BSA, however, the present study shows significant differences. Furthermore, it should be noted that the mortality in the smallest patients was approximately twice that of the largest patients.
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In the STS Database during the 1994 to 1996 time frame, we found that the IMA was used in 73.15% (252,288/344,913) of patients. In women, IMA grafting was performed in 65.25% (63,397/97,153), whereas in men 76.24% (188,891/247,760) received IMA grafts (p < 0.0001). This would seem to offer a partial explanation for the higher OM observed in women. When we examined all patients having IMA grafts, however, there was still a significantly higher mortality in women. For women with IMA grafting the OM was 3.30% (2,091/63,397), whereas for men with IMA grafting there was a 1.94% (3,667/188,891) mortality (p < 0.0001).
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Comment |
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TopAbstractIntroductionMaterial and methodsResultsCommentAppendix 1References |
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From these disparate conclusions it does not seem possible to determine whether gender is an independent risk factor for CABG operations. The most likely reason for differing conclusions is the fact that the risk profile for male and female populations is quite dissimilar [3, 5, 7, 12], thereby making direct comparisons particularly difficult.
Our findings support this observation. Table 2 shows the rate of each comorbid condition in male and female patients, confirming that men and women present with different risk factors. To further investigate this issue, we sought to determine whether there was a gender difference in those risk factors independently predictive of OM. A multivariate analysis of all risk factors was carried out for the male population and the female population and then compared (Table 8). Surprisingly, the risk factors were virtually identical in men and women, although the difference in beta coefficients indicates that the relative weight of some risk factors is quite different. This observation once again illustrates the difficulty in attempting direct comparisons between male and female populations.
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This, of course, is valuable information, but the problem is far too complex to be answered completely by univariate analysis. As mentioned above, the risk profile of men and women is quite different. This indicates that even though it is usually appropriate to directly compare two groups of men (or two groups of women) with a specific risk factor, it may be quite inappropriate to attempt a comparison between men and women having a common risk factor. This fact mandates a multifactorial analysis of the problem.
The use of risk models in this setting is particularly important because of the ability of such models to fully account for all important risk factors when assigning appropriate risk categories to patients. Such models can obviate the statistical fog created by a direct comparison of two groups having such disparate risk profiles. This type of risk stratification allows patients of truly similar risk to be directly compared. Surprisingly, these well-recognized assets of risk models have not been previously exploited in this context. When this approach was used with the present patient population, we found that women had significantly higher OM except at the higher end of the risk spectrum. It appears that when the operative risk approaches 30%, there is no significant difference in the outcome associated with patients of either gender.
This is a conclusion that has not been previously reported and there is no readily apparent explanation for it. Certainly we have mounting evidence that gender-specific responses to cardiovascular disease exist as real medical phenomena. For CABG operations, not only is immediate postoperative mortality increased in women, but also postoperative morbidity is higher [17] and long-term survival is lower [2, 17]. In addition, the mortality rate of women in the setting of acute myocardial infarction is higher as compared with men [18], and there are other distinct gender differences in autonomic reactions to abrupt coronary occlusion [19].
The role of estrogen is logically implicated in attempting to explain these observations. Certainly estrogen has a strong physiologic influence, conferring several cardioprotective effects by decreasing low-density lipoprotein levels, increasing high-density lipoprotein levels, enhancing endothelial function, and improving antioxidant activity. Estrogen replacement therapy has been shown to decrease the risk of restenosis after coronary atherectomy [20] and to improve long-term outcome after percutaneous transluminal coronary angioplasty [21] in postmenopausal women. These cardioprotective effects disappear gradually with aging rather than abruptly at the menopause. During this transition, other risk factors inherent in the aging process appear. These intrinsic gender differences in the cardiovascular system are recognized, but do not appear to shed light on a mechanism for observed clinical results.
The central question remains: Is gender an independent risk factor for coronary bypass grafting? The present study indicates that gender is indeed an independent risk factor except for very high-risk patients. In the high-risk part of the spectrum it appears that other, more compelling, risk factors dominate patient outcome and overshadow any differences in gender. For low-risk and medium-risk patients, women carry a significantly higher risk of CABG operative mortality as compared with equally matched male patients.
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Appendix 1 |
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TopAbstractIntroductionMaterial and methodsResultsCommentAppendix 1References |
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2 p values for entry and retention were 0.2 and 0.1, respectively. After the appropriate risk factors were determined, a standard logistic regression analysis was carried out using the "training set" population to develop a risk equation of the form P = 1/[1 + exp(-X)] where P is the probability of postoperative death, X = B0X0 + B1X1 + ... BkXk, each B value (beta coefficient) is a constant associated with a specific risk factor, and the X values denote the status of the risk factor for a given patient.
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References |
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|
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|
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|
|
|
|
|
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|
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 S R Messe, S E Kasner, Z Mehta, C P Warlow, P M Rothwell, and for the European Carotid Surgery Trialists Effect of body size on operative risk of carotid endarterectomy J. Neurol. Neurosurg. Psychiatry, December 1, 2004; 75(12): 1759 - 1761. [Abstract] [Full Text] [PDF]
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S. G. Raja Gender Difference Outcomes after Coronary Artery Surgery Asian Cardiovasc Thorac Ann, September 1, 2004; 12(3): 282 - 282. [Full Text] [PDF]
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V. Guru, S. E. Fremes, and J. V. Tu Time-related mortality for women after coronary artery bypass graft surgery: A population-based study J. Thorac. Cardiovasc. Surg., April 1, 2004; 127(4): 1158 - 1165. [Abstract] [Full Text] [PDF]
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N. Bairey Merz, R. O. Bonow, G. Sopko, R. S. Balaban, R. O. Cannon III, D. Gordon, M. M. Hand, S. N. Hayes, J. F. Lewis, T. Long, et al. Women's Ischemic Syndrome Evaluation: Current Status and Future Research Directions: Report of the National Heart, Lung and Blood Institute Workshop*: October 2-4, 2002 : Executive Summary Circulation, February 17, 2004; 109(6): 805 - 807. [Full Text] [PDF]
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V. Vaccarino and C. G. Koch Long-term benefits of coronary bypass surgery: Are the gains for women less than for men? J. Thorac. Cardiovasc. Surg., December 1, 2003; 126(6): 1707 - 1711. [Full Text] [PDF]
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C. G. Koch, F. Khandwala, N. Nussmeier, and E. H. Blackstone Gender and outcomes after coronary artery bypass grafting: a propensity-matched comparison J. Thorac. Cardiovasc. Surg., December 1, 2003; 126(6): 2032 - 2043. [Abstract] [Full Text] [PDF]
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C. G. Koch, F. Khandwala, N. Nussmeier, and E. H. Blackstone Gender profiling in coronary artery bypass grafting J. Thorac. Cardiovasc. Surg., December 1, 2003; 126(6): 2044 - 2051. [Abstract] [Full Text] [PDF]
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V. Vaccarino, Z. Q. Lin, S. V. Kasl, J. A. Mattera, S. A. Roumanis, J. L. Abramson, and H. M. Krumholz Sex Differences in Health Status After Coronary Artery Bypass Surgery Circulation, November 25, 2003; 108(21): 2642 - 2647. [Abstract] [Full Text] [PDF]
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N. K. Wenger Is what's good for the gander good for the goose? J. Thorac. Cardiovasc. Surg., October 1, 2003; 126(4): 929 - 931. [Full Text] [PDF]
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C. G. Koch, C. M. Mangano, N. Schwann, and V. Vaccarino Is it gender, methodology, or something else? J. Thorac. Cardiovasc. Surg., October 1, 2003; 126(4): 932 - 935. [Full Text] [PDF]
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J. S. Lawton, S. J. Brister, K. R. Petro, and M. Dullum Surgical revascularization in women: unique intraoperative factors and considerations J. Thorac. Cardiovasc. Surg., October 1, 2003; 126(4): 936 - 938. [Full Text] [PDF]
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L. L. Mickleborough, S. Carson, and J. Ivanov Gender differences in quality of distal vessels: effect on results of coronary artery bypass grafting J. Thorac. Cardiovasc. Surg., October 1, 2003; 126(4): 950 - 958. [Abstract] [Full Text] [PDF]
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C. W. Hogue Jr, R. Lillie, T. Hershey, S. Birge, A. M. Nassief, B. Thomas, and K. E. Freedland Gender influence on cognitive function after cardiac operation Ann. Thorac. Surg., October 1, 2003; 76(4): 1119 - 1125. [Abstract] [Full Text] [PDF]
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C. R. Bridges Cardiac surgery in African Americans Ann. Thorac. Surg., October 1, 2003; 76(4): S1356 - 1362. [Abstract] [Full Text] [PDF]
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F C Taylor, R Ascione, K Rees, P Narayan, and G D Angelini Socioeconomic deprivation is a predictor of poor postoperative cardiovascular outcomes in patients undergoing coronary artery bypass grafting Heart, September 1, 2003; 89(9): 1062 - 1066. [Abstract] [Full Text] [PDF]
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B. C. Reeves, R. Ascione, M. H. Chamberlain, and G. D. Angelini Effect of body mass index on early outcomes in patients undergoing coronary artery bypass surgery J. Am. Coll. Cardiol., August 20, 2003; 42(4): 668 - 676. [Abstract] [Full Text] [PDF]
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A. L. W. Shroyer, L. P. Coombs, E. D. Peterson, M. C. Eiken, E. R. DeLong, A. Chen, T. B. Ferguson Jr, F. L. Grover, and F. H. Edwards The society of thoracic surgeons: 30-day operative mortality and morbidity risk models Ann. Thorac. Surg., June 1, 2003; 75(6): 1856 - 1865. [Abstract] [Full Text] [PDF]
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 A. Sedrakyan, K. Gondek, D. Paltiel, and J. A. Elefteriades Volume Expansion With Albumin Decreases Mortality After Coronary Artery Bypass Graft Surgery Chest, June 1, 2003; 123(6): 1853 - 1857. [Abstract] [Full Text] [PDF]
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T. Athanasiou, S. Al-Ruzzeh, R. D. Stanbridge, R. P. Casula, B. E. Glenville, and M. Amrani Is the female gender an independent predictor of adverse outcome after off-pump coronary artery bypass grafting? Ann. Thorac. Surg., April 1, 2003; 75(4): 1153 - 1160. [Abstract] [Full Text] [PDF]
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A. K. Jacobs Coronary Revascularization in Women in 2003: Sex Revisited Circulation, January 28, 2003; 107(3): 375 - 377. [Full Text] [PDF]
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V. Vaccarino, Z. Q. Lin, S. V. Kasl, J. A. Mattera, S. A. Roumanis, J. L. Abramson, and H. M. Krumholz Gender differences in recovery after coronary artery bypass surgery J. Am. Coll. Cardiol., January 15, 2003; 41(2): 307 - 314. [Abstract] [Full Text] [PDF]
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 J. A. Fox, V. Formanek, A. Friedrich, and S. K. Shernan Intraoperative Echocardiography Card. Surg. Adult, January 1, 2003; 2(2003): 283 - 314. [Full Text]
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 L. Borowicz Jr., R. Royall, M. Grega, O. Selnes, C. Lyketsos, and G. McKhann Depression and Cardiac Morbidity 5 Years After Coronary Artery Bypass Surgery Psychosomatics, December 1, 2002; 43(6): 464 - 471. [Abstract] [Full Text] [PDF]
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P. P. Brown, M. J. Mack, A. W. Simon, S. Battaglia, L. Tarkington, S. Horner, S. D. Culler, and E. R. Becker Outcomes experience with off-pump coronary artery bypass surgery in women Ann. Thorac. Surg., December 1, 2002; 74(6): 2113 - 2119. [Abstract] [Full Text] [PDF]
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P. A. Kurlansky Invited commentary Ann. Thorac. Surg., December 1, 2002; 74(6): 2120 - 2120. [Full Text] [PDF]
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D. Zindrou, K. M. Taylor, and J. P. Bagger Excess coronary artery bypass graft mortality among women with hypothyroidism Ann. Thorac. Surg., December 1, 2002; 74(6): 2121 - 2125. [Abstract] [Full Text] [PDF]
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N. A. Nussmeier, M. R. Marino, and W. K. Vaughn Hormone replacement therapy is associated with improved survival in women undergoing coronary artery bypass grafting J. Thorac. Cardiovasc. Surg., December 1, 2002; 124(6): 1225 - 1229. [Abstract] [Full Text]
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P J Bradshaw, K Jamrozik, M Le, I Gilfillan, and P L Thompson Mortality and recurrent cardiac events after coronary artery bypass graft: long term outcomes in a population study Heart, December 1, 2002; 88(5): 488 - 494. [Abstract] [Full Text] [PDF]
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P. A. Kurlansky, E. A. Traad, D. L. Galbut, S. Singer, M. Zucker, and G. Ebra Coronary bypass surgery in women: a long-term comparative study of quality of life after bilateral internal mammary artery grafting in men and women Ann. Thorac. Surg., November 1, 2002; 74(5): 1517 - 1525. [Abstract] [Full Text] [PDF]
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R. Ascione, B. C. Reeves, K. Rees, and G. D. Angelini Effectiveness of Coronary Artery Bypass Grafting With or Without Cardiopulmonary Bypass in Overweight Patients Circulation, October 1, 2002; 106(14): 1764 - 1770. [Abstract] [Full Text] [PDF]
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R.-K. R. Chang, A. Y. Chen, and T. S. Klitzner Female Sex as a Risk Factor for In-Hospital Mortality Among Children Undergoing Cardiac Surgery Circulation, September 17, 2002; 106(12): 1514 - 1522. [Abstract] [Full Text] [PDF]
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J. E. Losanoff, B. W. Richman, and J. W. Jones Disruption and infection of median sternotomy: a comprehensive review Eur. J. Cardiothorac. Surg., May 1, 2002; 21(5): 831 - 839. [Abstract] [Full Text] [PDF]
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M. A. Williams, J. L. Fleg, P. A. Ades, B. R. Chaitman, N. H. Miller, S. M. Mohiuddin, I. S. Ockene, C. B. Taylor, and N. K. Wenger Secondary Prevention of Coronary Heart Disease in the Elderly (With Emphasis on Patients >=75 Years of Age): An American Heart Association Scientific Statement From the Council on Clinical Cardiology Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention Circulation, April 9, 2002; 105(14): 1735 - 1743. [Full Text] [PDF]
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Y. Zitser-Gurevich, E. Simchen, N. Galai, and M. Mandel Effect of perioperative complications on excess mortality among women after coronary artery bypass: The Israeli Coronary Artery Bypass Graft study (ISCAB) J. Thorac. Cardiovasc. Surg., March 1, 2002; 123(3): 517 - 524. [Abstract] [Full Text] [PDF]
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 N. K Wenger Clinical characteristics of coronary heart disease in women: emphasis on gender differences Cardiovasc Res, February 15, 2002; 53(3): 558 - 567. [Full Text] [PDF]
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N.A. Nussmeier, W.Y. Thong, M.R. Marino, C.L. Williams, and W.K. Vaughn Hormone replacement therapy improves the survival of women undergoing coronary artery bypass grafting Ann. Thorac. Surg., January 1, 2002; 73(1): S371 - 371. [Full Text] [PDF]
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 D. Zindrou, K. M. Taylor, and J. P. Bagger Admission Plasma Glucose: An independent risk factor in nondiabetic women after coronary artery bypass grafting Diabetes Care, September 1, 2001; 24(9): 1634 - 1639. [Abstract] [Full Text] [PDF]
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P. A. Kurlansky, E. A. Traad, D. L. Galbut, M. Zucker, and G. Ebra Efficacy of single versus bilateral internal mammary artery grafting in women: a long-term study Ann. Thorac. Surg., June 1, 2001; 71(6): 1949 - 1958. [Abstract] [Full Text] [PDF]
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C. W. Hogue Jr, B. Barzilai, K. S. Pieper, L. P. Coombs, E. R. DeLong, N. T. Kouchoukos, and V. G. Davila-Roman Sex Differences in Neurological Outcomes and Mortality After Cardiac Surgery : A Society of Thoracic Surgery National Database Report Circulation, May 1, 2001; 103(17): 2133 - 2137. [Abstract] [Full Text] [PDF]
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D. J. O'Rourke, D. J. Malenka, E. M. Olmstead, H. B. Quinton, J. H. Sanders Jr, S. J. Lahey, M. Norotsky, R. D. Quinn, Y. R. Baribeau, F. Hernandez Jr, et al. Improved in-hospital mortality in women undergoing coronary artery bypass grafting Ann. Thorac. Surg., February 1, 2001; 71(2): 507 - 511. [Abstract] [Full Text] [PDF]
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R. S. Hartz, A. V. Rao, M. E. Plomondon, F. L. Grover, and A. L. W. Shroyer Effects of race, with or without gender, on operative mortality after coronary artery bypass grafting: a study using The Society of Thoracic Surgeons national database Ann. Thorac. Surg., February 1, 2001; 71(2): 512 - 520. [Abstract] [Full Text] [PDF]
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T. A. Schwann, R. H. Habib, A. Zacharias, G. L. Parenteau, C. J. Riordan, S. J. Durham, and M. Engoren Effects of body size on operative, intermediate, and long-term outcomes after coronary artery bypass operation Ann. Thorac. Surg., February 1, 2001; 71(2): 521 - 530. [Abstract] [Full Text] [PDF]
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B. C. Astor, R. G. Kaczmarek, B. Hefflin, and W. R. Daley Mortality after aortic valve replacement: results from a nationally representative database Ann. Thorac. Surg., December 1, 2000; 70(6): 1939 - 1945. [Abstract] [Full Text] [PDF]
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C. R. Bridges, F. H. Edwards, E. D. Peterson, and L. P. Coombs The effect of race on coronary bypass operative mortality J. Am. Coll. Cardiol., November 15, 2000; 36(6): 1870 - 1876. [Abstract] [Full Text] [PDF]
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D. Abramov, M. G. Tamariz, J. Y. Sever, G. T. Christakis, G. Bhatnagar, A. L. Heenan, B. S. Goldman, and S. E. Fremes The influence of gender on the outcome of coronary artery bypass surgery Ann. Thorac. Surg., September 1, 2000; 70(3): 800 - 805. [Abstract] [Full Text] [PDF]
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R. D. Stewart, C. T. Campos, B. Jennings, S. S. Lollis, S. Levitsky, and S. J. Lahey Predictors of 30-day hospital readmission after coronary artery bypass Ann. Thorac. Surg., July 1, 2000; 70(1): 169 - 174. [Abstract] [Full Text] [PDF]
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C. S. Roberts Postoperative drug therapy to extend survival after coronary artery bypass grafting Ann. Thorac. Surg., May 1, 2000; 69(5): 1315 - 1316. [Full Text] [PDF]
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T. B. Ferguson Jr, S. W. Dziuban Jr, F. H. Edwards, M. C. Eiken, A. L. W. Shroyer, P. C. Pairolero, R. P. Anderson, and F. L. Grover The STS National Database: current changes and challenges for the new millennium Ann. Thorac. Surg., March 1, 2000; 69(3): 680 - 691. [Abstract] [Full Text] [PDF]
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A. T. Pezzella Reduction of wound healing problems after median sternotomy by use of retention sutures Ann. Thorac. Surg., November 1, 1999; 68(5): 1891 - 1892. [Full Text] [PDF]
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O. L. Godje, P. Lamm, T. Lange, and B. Reichart Reply Ann. Thorac. Surg., November 1, 1999; 68(5): 1892 - 1892. [Full Text] [PDF]
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E. Aidala, E. Lascala, and G. Poletti Gender and coronary artery bypass mortality Ann. Thorac. Surg., August 1, 1999; 68(2): 625 - 626. [Full Text] [PDF]
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F. H. Edwards Reply Ann. Thorac. Surg., August 1, 1999; 68(2): 626 - 626. [Full Text] [PDF]
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T. O. Cheng, A. K. Jacobs, S. F. Kelsey, M. M. Brooks, D. P. Faxon, B. R. Chaitman, V. Bittner, L. Dean, M. B. Mock, B. H. Weiner, et al. Women Versus Men Regarding Outcome of CABG or PTCA • Response Circulation, April 13, 1999; 99 (14): e1922 - e1926. [Full Text] [PDF]
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W.R. E. Jamieson, F. H. Edwards, M. Schwartz, J. W. Bero, R. E. Clark, and F. L. Grover Risk stratification for cardiac valve replacement. National Cardiac Surgery Database Ann. Thorac. Surg., April 1, 1999; 67(4): 943 - 951. [Abstract] [Full Text] [PDF]
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G. S. Aldea, J. M. Gaudiani, O. M. Shapira, A. K. Jacobs, J. Weinberg, A. L. Cupples, H. L. Lazar, and R. J. Shemin Effect of gender on postoperative outcomes and hospital stays after coronary artery bypass grafting Ann. Thorac. Surg., April 1, 1999; 67(4): 1097 - 1103. [Abstract] [Full Text] [PDF]
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