The full content of Annals is available to subscribers

Subscribe/Learn More  >
Original Research |

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

Harlan M. Krumholz, MD; Pamela S. Douglas, MD; Michael S. Lauer, MD; and Richard C. Pasternak, MD
[+] Article, Author, and Disclosure Information

Grant Support: In part by the National Heart, Lung, and Blood Institute Cardiovascular Research Training Grant HL-07374.

Requests for Reprints: Richard C. Pasternak, MD, Cardiac Unit, Massachusetts General Hospital, 32 Fruit Street, Boston, MA 02114.

Current Author Addresses: Drs. Krumholz and Douglas: Cardiovascular Division, Beth Israel Hospital, 330 Brookline Avenue, Boston, MA 02215.

Dr. Lauer: Section of Cardiology, Lahey Clinic Medical Center, 41 Mall Road, Burlington, MA 01805.

Dr. Pasternak: Cardiac Unit, Massachusetts General Hospital, 32 Fruit Street, Boston, MA 02114.

© 1992 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1992;116(10):785-790. doi:10.7326/0003-4819-116-10-785
Text Size: A A A

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.





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