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Sex-related differences in coronary revascularization practices: the perspective from a Canadian queue management
1Clinical Epidemiology Unit, Sunnybrook Health Science Centre, Toronto, ON.
Summary
Women with unstable angina were more likely to be denied coronary revascularization procedures like coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA) compared to men, despite having more severe symptoms.
Area of Science:
- Cardiology and Cardiovascular Surgery
- Health Services Research
- Medical Practice Patterns
Background:
- Sex-based disparities in healthcare access and outcomes are a significant concern in cardiovascular medicine.
- Understanding differences in the application of revascularization procedures between men and women is crucial for equitable patient care.
- Previous studies suggest potential biases in the referral and treatment of cardiovascular diseases based on sex.
Purpose of the Study:
- To investigate and quantify sex-related differences in the utilization of coronary revascularization procedures.
- To identify factors contributing to any observed disparities in coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) practices.
- To compare patient characteristics, procedural decisions, and waiting times between men and women undergoing revascularization.
Main Methods:
- Prospective analytic cohort study conducted at a regional referral office in Toronto.
- Inclusion of 131 women and 440 men referred for revascularization between January 1989 and June 1991.
- Data collection focused on symptom status, procedures requested and performed (CABG or PTCA), and time from referral to procedure.
Main Results:
- Women presented with more unstable angina (OR 2.28) but were more frequently denied procedures (16.8% vs. 12.1%).
- Significant sex-related differences in practice patterns persisted after adjusting for age and perceived risk.
- Coronary anatomy was the primary determinant of management, with sex being the only other significant variable (p=0.016); men were more likely to undergo CABG (OR 2.40).
Conclusions:
- Women in this cohort experienced higher rates of denial for revascularization despite more severe symptoms.
- Reduced utilization of coronary artery bypass grafting (CABG) in women, rather than percutaneous transluminal coronary angioplasty (PTCA), largely explained the sex-related differences.
- Women who underwent procedures had shorter waiting times, appropriately reflecting their more critical condition.