Sex-related differences in coronary revascularization practices: the perspective from a Canadian queue management project.
OBJECTIVE
To assess sex-related differences in coronary revascularization practices in a Canadian setting.


METHODS
Prospective analytic cohort study.


METHODS
Regional referral office in Toronto.


METHODS
A selected but consecutive group of 131 women and 440 men referred by cardiologists for revascularization procedures between Jan. 3, 1989, and June 30, 1991.


METHODS
Coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA). Nurse-coordinators placed the referral with a surgeon or interventional cardiologist at one of three hospitals, who then communicated directly with the referring cardiologist.


METHODS
Symptom status at referral, procedures requested and performed, and time from referral to procedure.


RESULTS
Although the women were more likely than the men to have unstable angina at the time of referral (odds ratio [OR] 2.28, 95% confidence interval [CI] 1.38 to 3.79, p = 0.0006), more women than men (16.8% v. 12.1%) were turned down for a procedure. Significant sex-related differences in practice patterns (p < 0.001) persisted after controlling for age or for the referring cardiologists' perception of expected procedural risk. A stepwise multivariate model showed that anatomy was the main determinant of case management; sex was the only other significant variable (p = 0.016). The referring physicians requested CABG more often for men than for women (p = 0.009), and the men accepted for a procedure were much more likely to undergo CABG than the women (OR 2.40, CI 1.47 to 3.93, p = 0.0002). Although the women undergoing CABG waited shorter periods than the men (p = 0.0035), this difference was attributable to their more severe symptoms.


CONCLUSIONS
In this selected group women had more serious symptoms before referral but were turned down for revascularization more often than men. Reduced use of CABG rather than PTCA largely accounted for the sex-related differences in revascularization. Once accepted for a procedure women had shorter waiting times, which was appropriate given their more severe symptoms.
Naylor
C D
CD
Clinical Epidemiology Unit, Sunnybrook Health Science Centre, Toronto, ON.
Levinton
C M
CM
D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D002170:Canada; D015331:Cohort Studies; D016001:Confidence Intervals; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D016017:Odds Ratio; D010865:Pilot Projects; D011446:Prospective Studies; D012017:Referral and Consultation; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome; D014850:Waiting Lists