REFERRAL PATTERN AND OUTCOME IN MEN AND WOMEN UNDERGOING CORONARY-ARTERY BYPASS-SURGERY - A CRITICAL-REVIEW

Women with coronary artery disease are less likely to undergo coronary artery bypass surgery, and this may represent a potential referral bi as in favor of men. A higher in-hospital mortality rate in women compa red with men has been reported earlier. Accumulating evidence currentl y suggests, however, that variables other than gender, such as advance d age, late referral, angina classification, diabetes mellitus, concur rent medical conditions, the number of diseased vessels, the caliber o f 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 signifi cant predictor of operative mortality. Women appear to have comparable immediate and late survival rates. Recurrent angina, perioperative my ocardial infarction, congestive heart failure, incomplete revasculariz ation, and early and late graft reocclusion following surgery are, how ever, more prevalent in women. Men and women show differences in recov ery experiences after discharge following bypass surgery. When coronar y bypass surgery is offered to women, the decision should be individua lized, based on the patients' perioperative baseline clinical risk fac tors and coronary anatomy. Coronary artery bypass surgery should not b e withheld in women who are considered to be appropriate candidates fo r fear of a reduced success rate.