CORONARY-ARTERY SURGERY IN WOMEN - INCREASED SURGICAL RISK OR REFERRAL BIAS

During the last fifteen years the increased morbimortality of coronary surgery in women has been widely documented. Traditionally, the incre ased risk has been attributed to the smaller size of the coronary arte ries of female patients. Ho Never, there are data in our series and in various others that lead to suspicion that there might exist a referr al bias, which causes women to be referred to a surgeon at a more adva nced age and in a worse clinical condition than men. This bias, if it is present, could contribute to the worse results obtained in coronary artery bypass surgery in women. The only way to determine if this is valid is by applying similar criteria of management to both sexes. Onl y in this way will it be possible to ascertain if the high morbimortal ity of myocardial revascularization surgery in women is due to factors that are related to the gender itself or to referral bias stated abov e.