The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Increased Mortality of Women in Coronary Artery Bypass Surgery: Evidence for Referral Bias

Steven S. Khan, MD; Sharon Nessim, DrPH; Richard Gray, MD; Lawrence S. Czer, MD; Aurelio Chaux, MD; and Jack Matloff, MD
[+] Article, Author, and Disclosure Information

Requests for Reprints: Steven Khan, MD, Cedars-Sinai Medical Center, 8700 Beverly Blvd., #6215, Los Angeles, CA 90048.

Current Author Addresses: Drs. Khan, Nessim, Gray, Czer, Chaux, and Matloff: Cedars-Sinai Medical Center, 8700 Beverly Blvd., #6215, Los Angeles, CA 90048.

©1990 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1990;112(8):561-567. doi:10.7326/0003-4819-112-8-561
Text Size: A A A

Study Objective: To determine whether differences in referral reasons explain the higher operative mortality of women in coronary artery bypass surgery.

Design: Case series.

Setting: A tertiary care, private teaching hospital.

Patients: Consecutive patients who had isolated coronary artery bypass surgery between 1982 and 1987 (total, 2297; 79% male and 21% female).

Measurements and Main Results: The inhospital mortality rate was significantly higher for women than for men (4.6% compared with 2.6%; P = 0.036; 95% CI for difference in mortality, 0% to 4.0%). Women were older than men (mean, 68.2 and 64.0 years, respectively; P < 0.001), and a higher percentage of women were referred with unstable angina (P = 0.007), postmyocardial infarction angina (P = 0.029), congestive heart failure (P < 0.001), and New York Heart Association class IV symptoms (66% compared with 45%, P < 0.001). More men were referred with a history of an abnormal exercise test (P < 0.001), and patients referred because of a positive exercise test had a lower mortality (P < 0.001). Using multivariate analysis, adjustment for the higher preoperative functional class of women and for age accounted for all of the difference in mortality between men and women (odds ratio, 1.04; CI, 0.60 to 1.79; P = 0.89). After correction for functional class alone, there continued to be no significant difference in mortality between men and women (P = 0.40).

Conclusions: Differences in functional class and age account for the higher operative mortality of women in coronary bypass surgery. Women are referred for coronary bypass surgery later in the course of their disease than men, and later referral may increase their chances of operative death.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $42.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.