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.