SEX-RELATED DIFFERENCES IN CORONARY REVASCULARIZATION PRACTICES - THEPERSPECTIVE FROM A CANADIAN QUEUE MANAGEMENT PROJECT

Objective: To assess sex-related differences in coronary revasculariza tion practices in a Canadian setting. Design: Prospective analytic coh ort study. Setting: Regional referral office in Toronto. Patients: A s elected but consecutive group of 131 women and 440 men referred by car diologists for revascularization procedures between Jan. 3, 1989, and June 30, 1991. Interventions: Coronary artery bypass grafting (CABG) o r percutaneous transluminal coronary angioplasty (PTCA). Nurse-coordin ators placed the referral with a surgeon or interventional cardiologis t at one of three hospitals, who then communicated directly with the r eferring cardiologist. Main outcome measures: Symptom status at referr al, procedures requested and performed, and time from referral to proc edure. Results: Although the women were more likely than the men to ha ve 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 me n (16.8% v. 12.1%) were turned down for a procedure. Significant sex-r elated differences in practice patterns (p < 0.001) persisted after co ntrolling for age or for the referring cardiologists' perception of ex pected procedural risk. A stepwise multivariate model showed that anat omy was the main determinant of case management; sex was the only othe r significant variable (p = 0.016). The referring physicians requested CABG more often for men than for women (p = 0.009), and the men accep ted for a procedure were much more likely to undergo CABG than the wom en (OR 2.40, CI 1.47 to 3.93, p = 0.0002). Although the women undergoi ng CABG waited shorter periods than the men (p = 0.0035), this differe nce was attributable to their more severe symptoms. Conclusions: In th is selected group women had more serious symptoms before referral but were turned down for revascularization more often than men. Reduced us e of CABG rather than PTCA largely accounted for the sex-related diffe rences in revascularization. Once accepted for a procedure women had s horter waiting times, which was appropriate given their more severe sy mptoms.