title: Coronary artery bypass graft surgery and primary percutaneous coronary intervention choices in patients with similar coronary anatomy: A computer-based simulation examines the sex gap.
abstract: BACKGROUND
  Sex differences (or a 'sex gap') exist in the rates of cardiac revascularization. It was evaluated whether physician preference contributes to this difference.
  
  
  OBJECTIVE
  To obtain information on how cardiac specialists manage male and female patients being evaluated for coronary artery disease.
  
  
  METHODS
  A computer-based patient simulation program was developed. Six sex-matched clinical vignettes (three pairs) with uninterpreted coronary angiograms were shown to specialists, who were blinded to the purpose of the study. The sex-matched scenarios were balanced with respect to symptoms, comorbidities and coronary anatomy. Physicians were surveyed on management and rationale.
  
  
  RESULTS
  Fifty physicians were surveyed, consisting mainly of cardiologists from tertiary cardiac centres in Ontario. Among the three sexmatched pairs, the frequencies at which percutaneous coronary intervention (including drug-eluting stents), bypass surgery and medical therapy were chosen did not differ across sexes. The means for men and women, respectively, were 47% and 50% for percutaneous coronary intervention, 32% and 26% for bypass surgery, and 21% and 24% for medical treatment.
  
  
  CONCLUSIONS
  In the present pilot study, cardiac specialists chose similar rates of medical, interventional and surgical procedures independent of a patient's sex. Although large registry trials show that sex differences in management exist, the present data suggest that cardiac specialist preference is less likely to be a factor if coronary angiography was performed. Further research is required to explore the causes of sex discrepancies in cardiac care.
authors.affiliation: St Michael's Hospital, University of Toronto, Toronto, Canada.
authors.forename: B M
authors.initials: BM
authors.lastname: Meyers
authors.forename: T
authors.initials: T
authors.lastname: Vira
authors.forename: Chi- Ming
authors.initials: C
authors.lastname: Chow
authors.forename: B L
authors.initials: BL
authors.lastname: Abramson
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000592:standards* / Q000639:trends; D001291:Attitude of Health Personnel; D002309:Cardiology / Q000592:standards / Q000639:trends; D003198:Computer Simulation; D016001:Confidence Intervals; D001026:Coronary Artery Bypass / Q000592:standards* / Q000639:trends; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D005260:Female; D019538:Health Care Surveys; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010865:Pilot Projects; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends; D011336:Probability; D011787:Quality of Health Care; D011859:Radiography; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D016896:Treatment Outcome