诊断性冠状动脉造影术后冠状动脉血运重建术的转诊：存在性别偏见的证据？

Referral for coronary artery revascularization procedures after diagnostic coronary angiography: evidence for gender bias?

作者信息

Bell M R, Berger P B, Holmes D R, Mullany C J, Bailey K R, Gersh B J

机构信息

Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.

出版信息

J Am Coll Cardiol. 1995 Jun;25(7):1650-5. doi: 10.1016/0735-1097(95)00044-5.

DOI:10.1016/0735-1097(95)00044-5

PMID:7759719

Abstract

OBJECTIVES

We sought to determine whether there is a gender bias in the selection of patients for coronary revascularization once the severity of the underlying coronary artery disease has been established with angiography.

BACKGROUND

It has been suggested that women with coronary artery disease are less likely to be referred for coronary angiography and coronary artery bypass surgery than men. Whether such a referral bias for revascularization procedures, including coronary angioplasty, is present once angiography has been performed is not clear.

METHODS

We retrospectively analyzed 22,795 patients with suspected coronary artery disease who underwent coronary angiography between 1981 and 1991 and compared the numbers of women and men who underwent either coronary artery bypass surgery or coronary angioplasty within 30 days of coronary angiography.

RESULTS

Angiography revealed significant (one-vessel or more) disease in 15,455 patients (52% of women, 76% of men). Despite worse symptoms, women had less extensive coronary disease than men as judged by the number of vessels diseased. Women were also more likely to have other co-morbid diseases. An equal proportion of women (54%) and men underwent revascularization procedures. After adjustment for baseline differences and age, differences in the two individual revascularization strategies were very small: More women tended to have coronary angioplasty ([absolute difference +/- 1 SD] + 3.3 +/- 0.7%, p < 0.0001), but fewer had coronary artery bypass surgery than men (-2.5 +/- 0.8%, p = 0.003). When the two revascularization strategies were considered together, there was no significant gender difference in overall adjusted use of revascularization (+ 0.8 +/- 0.9%, p = 0.41).

CONCLUSIONS

Once diagnostic coronary angiography had been performed, no major differences in the overall utilization of revascularization procedures were noted for women compared with men.

摘要

目的

我们试图确定，在通过血管造影确定潜在冠状动脉疾病的严重程度后，冠状动脉血运重建患者的选择是否存在性别偏见。

背景

有人提出，患有冠状动脉疾病的女性比男性接受冠状动脉造影和冠状动脉搭桥手术的可能性更小。血管造影后是否存在这种针对包括冠状动脉成形术在内的血运重建手术的转诊偏见尚不清楚。

方法

我们回顾性分析了1981年至1991年间接受冠状动脉造影的22795例疑似冠状动脉疾病患者，并比较了冠状动脉造影后30天内接受冠状动脉搭桥手术或冠状动脉成形术的女性和男性人数。

结果

血管造影显示15455例患者（女性的52%，男性的76%）存在显著（单支或多支血管）病变。尽管症状更严重，但从病变血管数量判断，女性的冠状动脉疾病程度不如男性严重。女性也更有可能患有其他合并症。接受血运重建手术的女性（54%）和男性比例相等。在对基线差异和年龄进行调整后，两种个体血运重建策略的差异非常小：更多女性倾向于接受冠状动脉成形术（[绝对差异±1标准差]+3.3±0.7%，p<0.0001），但接受冠状动脉搭桥手术的女性比男性少（-2.5±0.8%，p=0.003）。当将两种血运重建策略综合考虑时，总体调整后的血运重建使用情况在性别上没有显著差异（+0.8±0.9%，p=0.41）。