Jaglal S B, Slaughter P M, Baigrie R S, Morgan C D, Naylor C D
Division of Cardiology, Sunnybrook Health Science Centre, Toronto, Ont.
CMAJ. 1995 Mar 15;152(6):873-80.
To examine the sex-specific prevalence of referral to a cardiologist for noninvasive ischemic testing (NIIT) or angiography among outpatients with clinical suspicion of new coronary artery disease (CAD).
Retrospective records-based cohort study.
Group cardiology referral practice in a tertiary care teaching hospital in Toronto.
Of 1212 new patients referred between Mar. 1, 1991, and Mar. 31, 1993, 339 (232 men and 107 women) had symptoms of CAD and had initiation or modification of antianginal therapy, or were prescribed NIIT or angiography by their cardiologist.
Rates of prior NIIT and of subsequent diagnostic procedures for women and men.
Women were less likely than men to have had prior NIIT (51 [47.7%] v. 162 [69.8%]) (p < 0.001). Women with class I or II angina were less likely than their male counterparts to have had prior NIIT (20/40 [50.0%] v. 84/109 [77.1%]) (p = 0.001); a similar difference was found between women and men with class III or IV angina (5/15 [33.3%] v. 43/60 [71.7%]) (p = 0.006). Men and women with atypical angina were equally likely to have had prior NIIT. Among patients with a positive initial NIIT result a higher proportion of women than of men did not have any further testing done by the cardiologist (53.5% v. 33.7%) (p = 0.02). Cardiologists referred a higher proportion of women (40.2%) than of men (25.4%) for NIIT (p = 0.006) and, for patients with a positive prior NIIT result, were also more likely to refer women (25.7% [9/43]) than men (12.0% [16/133]) for further NIIT (p = 0.04). Women with a positive prior NIIT result were more likely than their male counterparts to have a negative retest result (42.8% v. 18.2%). After adjustment for age, anginal class and overall result of NIIT, women were less likely than men to be referred for angiography (odds ratio 1.4), although the difference was not significant.
In this exploratory study sex-related differences in patterns of use of NIIT by cardiologists seem largely based on differences in testing before referral by family physicians and general internists.
探讨临床怀疑患有新发冠状动脉疾病（CAD）的门诊患者中，因无创缺血检测（NIIT）或血管造影而转诊至心脏病专家处的性别特异性患病率。
基于回顾性记录的队列研究。
多伦多一家三级护理教学医院的心脏病专家转诊科室。
在1991年3月1日至1993年3月31日期间转诊的1212名新患者中，339名（232名男性和107名女性）有CAD症状，开始或调整了抗心绞痛治疗，或被心脏病专家开具了NIIT或血管造影检查。
女性和男性既往NIIT的发生率以及后续诊断程序的发生率。
女性比男性更不可能接受过既往NIIT（51例[47.7%]对162例[69.8%]）（p<0.001）。I级或II级心绞痛女性比男性更不可能接受过既往NIIT（20/40[50.0%]对84/109[77.1%]）（p = 0.001）；III级或IV级心绞痛女性和男性之间也发现了类似差异（5/15[33.3%]对43/60[71.7%]）（p = 0.006）。非典型心绞痛的男性和女性接受既往NIIT的可能性相同。在初始NIIT结果为阳性的患者中，未由心脏病专家进行任何进一步检查的女性比例高于男性（53.5%对33.7%）（p = 0.02）。心脏病专家将更高比例的女性（40.2%）而非男性（25.4%）转诊进行NIIT（p = 0.006），并且对于既往NIIT结果为阳性的患者，转诊女性（25.7%[9/43]）进行进一步NIIT的可能性也高于男性（12.0%[16/133]）（p = 0.04）。既往NIIT结果为阳性的女性比男性更有可能出现复测结果为阴性（42.8%对18.2%）。在调整年龄、心绞痛分级和NIIT总体结果后，女性被转诊进行血管造影的可能性低于男性（优势比1.4），尽管差异不显著。
在这项探索性研究中，心脏病专家使用NIIT模式的性别差异似乎主要基于家庭医生和普通内科医生转诊前检查的差异。
