title: Gender differences and temporal trends in clinical characteristics, stress test results and use of invasive procedures in patients undergoing evaluation for coronary artery disease.
abstract: OBJECTIVE
  This study examined gender differences and temporal changes in the clinical characteristics of patients referred for nuclear stress imaging, their imaging results and subsequent utilization of coronary angiography and revascularization.
  
  
  BACKGROUND
  Gender bias may influence resource utilization in patients with coronary artery disease (CAD). No study has analyzed gender differences and time trends in patients referred for noninvasive testing and subsequent use of invasive procedures.
  
  
  METHODS
  Between January 1986 and December 1995, 14,499 patients (5,910 women and 8,589 men) without established CAD underwent stress myocardial perfusion imaging. The clinical characteristics, imaging results, coronary angiograms and revascularization outcomes were compared in women and men over time.
  
  
  RESULTS
  The mean pretest probability of CAD was lower in women (45%) than in men (70%) (p < 0.001). More women (69%) than men (42%) had normal nuclear images (p < 0.001). Men (17%) were more likely than women (8%) to undergo coronary angiography (p < 0.001). Male gender was independently associated with referral for coronary angiography (multivariate model: chi-square = 16, p < 0.001) but was considerably weaker than the imaging variables (summed reversibility score: chi-square = 273, p < 0.001). Revascularization was performed in more men (46% of the population undergoing angiography) than women (39%) (p = 0.01), but gender was not independently associated with referral to revascularization. There were no significant differences in clinical, imaging or invasive variables between the genders over time.
  
  
  CONCLUSIONS
  There was little evidence for a bias against women in this study. Women were somewhat less likely to undergo coronary angiography but were referred for stress perfusion imaging more liberally. Practice patterns remained constant over this 10-year period.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA. miller.todd@mayo.edu
authors.forename: T D
authors.initials: TD
authors.lastname: Miller
authors.forename: V L
authors.initials: VL
authors.lastname: Roger
authors.forename: D O
authors.initials: DO
authors.lastname: Hodge
authors.forename: M R
authors.initials: MR
authors.lastname: Hopfenspirger
authors.forename: K R
authors.initials: KR
authors.lastname: Bailey
authors.forename: R J
authors.initials: RJ
authors.lastname: Gibbons
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D015982:Bias; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon / Q000706:statistics & numerical data*
chemical_list: D013794:Thallium Radioisotopes