15 May 1992

Selection of Patients for Coronary Angiography and Coronary Revascularization Early after Myocardial Infarction: Is There Evidence for a Gender Bias?

Publication: Annals of Internal Medicine
Volume 116, Number 10


Objective: To determine whether a gender bias exists in the selection of patients for diagnostic and therapeutic cardiovascular procedures early after myocardial infarction.
Design: A retrospective cohort study.
Setting: A community-based tertiary care teaching hospital.
Patients: A total of 2473 consecutive patients with a principal discharge diagnosis of acute myocardial infarction and a peak creatine kinase MB fraction of at least 4%.
Measurements: Comparison of men and women regarding the frequency with which they underwent various cardiac procedures.
Results: Women had coronary angiography during hospitalization for myocardial infarction much less frequently than men (odds ratio, 0.55; 95% Cl, 0.46 to 0.65), but the age-adjusted rates were similar in women and men (odds ratio, 0.91; Cl, 0.75 to 1.12). An abnormal ejection fraction (<50%) was equally frequent in women and men who underwent left ventriculography (odds ratio, 0.85; Cl, 0.56 to 1.30). Among patients who had coronary angiography, women had a significantly lower rate of severe coronary artery disease, defined as either a left main stenosis of more than 50%, three-vessel disease, or two-vessel disease with a proximal left anterior descending stenosis of more than 70% (odds ratio, 0.67; Cl, 0.48 to 0.93). When adjustments were made for age, women had percutaneous transluminal coronary angioplasty as often as men (odds ratio, 1.16; Cl, 0.83 to 1.62) but had coronary artery bypass graft surgery significantly less frequently (odds ratio, 0.58; Cl, 0.37 to 0.91). When adjustments were made for age and the severity of coronary artery disease, the difference in rates was of borderline significance (odds ratio, 0.65; Cl, 0.41 to 1.01).
Conclusions: No evidence of a difference in the rate of coronary angiography early after myocardial infarction between women and men was found after age adjustment. Among patients who have cardiac catheterization early after myocardial infarction, women and men are equally likely to have angioplasty, but women are less likely than men to have coronary artery bypass surgery.

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Tobin JWassertheil-Smoller SWexler JSteingart RBudner N, and Lense L. Sex bias in considering coronary bypass surgery. Ann Intern Med. 1987;107:19-25.
Ayanian J and Epstein A. Differences in the use of procedures between women and men hospitalized for coronary heart disease. N Engl J Med. 1991;325:221-5.
Steingart RPacker MHamm PCoglianese MGersh B, and Geltman E. Sex differences in the management of coronary artery disease. N Engl J Med. 1991;325:226-30.
Khan SNessim SGray RCzer LChaux A, and Matloff J. Increased mortality of women in coronary artery bypass surgery: evidence for a referral bias. Ann Intern Med. 1990;112:561-7.
Kennedy RKennedy MFrye RGiuliani EMcGoon D, and Pluth J. Cardiac catheterization and cardiac surgical facilities: use, trends, and future requirements. N Engl J Med. 1982;307: 986-93.
Gillum R. Coronary artery bypass surgery and coronary angiography in the United States, 1979-1983. Am Heart J. 1987;113:1255-60.
Healy B. The Yentl syndrome [Editorial]. N Engl J Med. 1991;325: 274-6.
Safran CPorter DLightfoot JRury CUnderbill L, and Bleich H. ClinQuery: a system for online searching of data in a teaching hospital. Ann Intern Med. 1989;111:751-6.
Rosner B. Fundamentals of Biostatistics. Boston: Duxbury Press; 1986.
Wenger N. Gender, coronary artery disease, and coronary bypass surgery [Editorial]. Ann Intern Med. 1990;112:557-8.
Iezzoni LBurnside SSickles LMoskowitz MSawitz E, and Levine P. Coding of acute myocardial infarction. Ann Intern Med. 1988; 109:745-51.
Loop FGolding LMacMillan JCosgrove DLytle B, and Sheldon W. Coronary artery surgery in women compared with men: analyses of risks and long-term results. J Am Coll Cardiol. 1983;1:383-90.
Fisher LKennedy JDavis KMaynard CFritz J, and Kaiser G. Association of sex, physical size, and operative mortality after coronary artery bypass in the Coronary Artery Surgical Study (CASS). J Thorac Cardiovasc Surg. 1982;84:334-41.
Bolooki HVargas AGreen RKaiser G, and Ghahramani A. Results of direct coronary artery surgery in women. J Thorac Cardiovasc Surg. 1975;69:271-9.
Tofler GStone PMuller JWillich SDavis V, and Poole W. Effects of gender and race on prognosis after myocardial infarction: adverse prognosis for women, particularly black women. J Am Coll Cardiol. 1987;9:473-82.
Greenland PReicher-Reiss HGoldbourt U, and Behar S. In-hospital and 1-year mortality in 1524 women after myocardial infarction. Circulation. 1991;83:484-91.
Fiebach NViscoli C, and Horwitz R. Differences between women and men in survival after myocardial infarction. JAMA. 1990;263:1092-6.
Dittrich HGilpin ENicod PCali GHenning H, and Ross J. Acute myocardial infarction in women: influence of gender on mortality and prognostic variables. Am J Cardiol. 1988;62:1-7.
Merilees MScott P, and Norris R. Prognosis after myocardial infarction: results of 15 year follow-up. Br Med J. 1984;288:356-9.
Lerner D and Kannel W. Patterns of coronary heart disease morbidity and mortality in the sexes: a 26-year follow-up of the Framingham population. Am Heart J. 1986;111:383-90.
Johansson SBergstrand RSchlossman DSelin KVedin A, and Wilhelmsson C. Sex differences in cardioangiographic findings after myocardial infarction. Eur Heart J. 1984;5:374-81.
Zir LMiller SDinsmore RGilbert J, and Harthorne J. Interobserver variability in coronary angiography. Circulation. 1976; 53:627-32.

Information & Authors


Published In

cover image Annals of Internal Medicine
Annals of Internal Medicine
Volume 116Number 1015 May 1992
Pages: 785 - 790


Published in issue: 15 May 1992
Published online: 1 December 2008




Harlan M. Krumholz, MD
Pamela S. Douglas, MD
Richard C. Pasternak, MD
For current author affiliations and addresses, see end of text.

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Harlan M. Krumholz, Pamela S. Douglas, Michael S. Lauer, et al. Selection of Patients for Coronary Angiography and Coronary Revascularization Early after Myocardial Infarction: Is There Evidence for a Gender Bias?. Ann Intern Med.1992;116:785-790. doi:10.7326/0003-4819-116-10-785

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