Gender differences in diagnosis and treatment of coronary artery disease from 1981 to 1997 - No evidence for the Yentl syndrome

Aims The aim of the present clinical study was to evaluate whether gender-r elated differences existed as regards the extent and localization of corona ry artery lesions in patients with angiographically documented coronary art ery disease, and whether these angiographic findings would lead to differen ces in further management. Methods and results Over a 16-year period (1981-1997) we evaluated 1894 pat ients (1526 men, 368 women) with angiographically documented coronary arter y disease (luminal stenosis greater than or equal to 60%). For each patient the coronary angiographic results and subsequent revascularization procedu res (percutaneous transluminal coronary angioplasty or coronary artery bypa ss graft surgery) were analysed. The study period was divided into the earl y angioplasty years (1981 to 1989) and the current angioplasty years (1990- 1997). No gender differences in extent and localization of coronary angiogr aphic lesions were observed. In men and women the incidence of single-vesse l disease was 42% and 40%, two-vessel disease 27% and 27%, three-vessel dis ease 26% and 24%, and left main disease 5% and 8%, respectively (P=ns). Loc alization of disease in men and women was 36% and 39% for the left anterior descending coronary artery, 34% and 32% for the right coronary artery, and 27% and 26% for the left circumflex coronary artery, respectively (P=ns). There was a significant shift from multi-vessel disease towards single-vess el disease in both men and women (both P<0.001). As to subsequent managemen t, a significant gender difference in favour of women was observed (P=0.021 ). Over time, the number of angioplasty procedures increased significantly from 11.6% to 23.2% for men (P<0.001), and for women from 17.6% to 28.0% (P =0.025), whereas the number of coronary artery bypass procedures decreased in men from 34.9% to 29.5% (P=0.024) and in women from 42.6% to 30.6% (P=0. 019). Referral to angioplasty (n=535) and coronary artery bypass surgery (n =616) in relation to the extent of the disease did not show any gender bias in favour of men. Conclusions Our angiographic findings did not show significant gender diffe rences as regards the extent and localization of coronary artery disease in patients with angiographically documented coronary artery disease. More im portantly, no substantial evidence could be found for under-referral of wom en to subsequent therapeutic management. Therefore our study questions the presence of Yentl syndrome in the current era. (Eur Heart J 2000; 21: 911-9 18) (C) 2000 The European Society of Cardiology.