title: Referral pattern and outcome in men and women undergoing coronary artery bypass surgery--a critical review.
abstract: Women with coronary artery disease are less likely to undergo coronary artery bypass surgery, and this may represent a potential referral bias in favor of men. A higher in-hospital mortality rate in women compared with men has been reported earlier. Accumulating evidence currently suggests, however, that variables other than gender, such as advanced age, late referral, angina classification, diabetes mellitus, concurrent medical conditions, the number of diseased vessels, the caliber of coronary arteries, and the decreased body surface area in women may have accounted for this difference. In fact, when these variables are taken into account, female gender is no longer a statistically significant predictor of operative mortality. Women appear to have comparable immediate and late survival rates. Recurrent angina, perioperative myocardial infarction, congestive heart failure, incomplete revascularization, and early and late graft reocclusion following surgery are, however, more prevalent in women. Men and women show differences in recovery experiences after discharge following bypass surgery. When coronary bypass surgery is offered to women, the decision should be individualized, based on the patients' perioperative baseline clinical risk factors and coronary anatomy. Coronary artery bypass surgery should not be withheld in women who are considered to be appropriate candidates for fear of a reduced success rate.
authors.affiliation: Department of Cardiology, St. Francis Hospital of Evanston, Illinois 60202, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Hussain
authors.forename: A
authors.initials: A
authors.lastname: Kogan
authors.forename: A Q
authors.initials: AQ
authors.lastname: Estrada
authors.forename: G
authors.initials: G
authors.lastname: Kostandy
authors.forename: A
authors.initials: A
authors.lastname: Foschi
authors.forename: S
authors.initials: S
authors.lastname: Dadkhah
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000787:Angina Pectoris / Q000145:classification; D015982:Bias; D001830:Body Surface Area; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003326:Coronary Circulation; D003327:Coronary Disease / Q000473:pathology / Q000601:surgery; D003331:Coronary Vessels / Q000473:pathology; D003657:Decision Making; D048909:Diabetes Complications; D005260:Female; D005544:Forecasting; D006083:Graft Occlusion, Vascular / Q000209:etiology; D006333:Heart Failure / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D010351:Patient Discharge; D015995:Prevalence; D011788:Quality of Life; D012008:Recurrence; D012017:Referral and Consultation; D012307:Risk Factors; D012737:Sex Factors; D015996:Survival Rate; D016896:Treatment Outcome; D016387:Women's Health