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Sex Differences in Access to Coronary Revascularization after Cardiac Catheterization: Importance of Detailed Clinical Data

William A. Ghali, MD, MPH; Peter D. Faris, PhD; P. Diane Galbraith, BN; Colleen M. Norris, MSc; Michael J. Curtis, MD; L. Duncan Saunders, PhD; Vladimir Dzavik, MD; L. Brent Mitchell, MD; Merril L. Knudtson, MD, Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) Investigators*
[+] Article and Author Information

From University of Calgary, Calgary; University of Alberta, Edmonton; and the APPROACH Project Offices, Calgary and Edmonton, Alberta, Canada.


Acknowledgment: The authors thank the Calgary Regional Health Authority and the Capital Health Authority for assistance with on-line data entry by cardiac catheterization laboratory personnel.

Grant Support: The APPROACH initiative was initially funded in 1995 by a grant from the Weston Foundation. The ongoing operation of the project has been made possible by contributions from the Province-Wide Services Committee of Alberta Health and Wellness, Merck Frosst Canada, Inc.; Monsanto Canada, Inc.–Searle; Eli Lilly Canada, Inc.; Guidant Corp.; Boston Scientific, Ltd.; Hoffmann–La Roche, Ltd.; and Johnson & Johnson, Inc.–Cordis. Analysis was supported by an operating grant from the Heart and Stroke Foundation of Canada. Dr. Ghali is supported by a Population Health Investigator Award from the Alberta Heritage Foundation for Medical Research, Edmonton, Alberta, and by a Government of Canada Research Chair in Health Services Research.

Requests for Single Reprints: William A. Ghali, MD, MPH, Faculty of Medicine, University of Calgary, 3330 Hospital Drive Northwest, Calgary, Alberta T2N 4N1, Canada; e-mail, wghali@ucalgary.ca.

Potential Financial Conflicts of Interest: None disclosed.

Current Author Addresses: Dr. Ghali: University of Calgary, 3330 Hospital Drive Northwest, Calgary, Alberta T2N 4N1, Canada.

Dr. Faris and Ms. Galbraith: c/o Centre for Health and Policy Studies, 3330 Hospital Drive Northwest, Calgary, Alberta T2N 4N1, Canada.

Ms. Norris: APPROACH Project Office, 8111 1st Floor ABC, 8440—112 Street, Edmonton, Alberta T6G 2B7, Canada.

Drs. Curtis, Mitchell, and Knudtson: Foothills Hospital, 1403—29th Street Northwest, Calgary, Alberta T2N 2T9, Canada.

Dr. Saunders: University of Alberta, Room 13-106, 8440—112th Street, Edmonton, Alberta T6G 2B7, Canada.

Dr. Dzavik: 200 Elizabeth Street, EN 12-244a, Toronto, Ontario M5G 2C4, Canada.

Author Contributions: Conception and design: WA Ghali, LD Saunders, LB Mitchell, ML Knudtson.

Analysis and interpretation of the data: WA Ghali, PD Faris, PD Galbraith, CM Norris, MJ Curtis, ML Knudtson.

Drafting of the article: WA Ghali.

Critical revision of the article for important intellectual content: PD Faris, PD Galbraith, CM Norris, MJ Curtis, LD Saunders, V Dzavik, ML Knudtson.

Final approval of the article: WA Ghali, PD Galbraith, MJ Curtis, LD Saunders, V Dzavik, LB Mitchell, ML Knudtson.

Provision of study materials or patients: WA Ghali, V Dzavik, ML Knudtson.

Statistical expertise: WA Ghali, PD Faris, CM Norris.

Obtaining of funding: WA Ghali, LD Saunders, ML Knudtson.

Administrative, technical, or logistic support: WA Ghali, PD Galbraith, V Dzavik.

Collection and assembly of data: WA Ghali, PD Galbraith, V Dzavik.


Ann Intern Med. 2002;136(10):723-732. doi:10.7326/0003-4819-136-10-200205210-00007
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A total of 21 816 patients underwent cardiac catheterization in Alberta between 1 January 1995 and 31 December 1998. Of these patients, 15 409 (70.6%) were men and 6407 (29.4%) were women. Within 1 year after catheterization, 8488 of the 15 409 men (55.1%) had undergone a revascularization procedure (PCI or CABG surgery) compared with only 2574 of the 6407 women (40.2%) (P < 0.001). The proportion having undergone PCI at 1 year was 32.2% for men versus 26.1% for women (P < 0.001). The proportion having CABG surgery by 1 year after catheterization was 22.9% for men and only 14.0% for women (P < 0.001). In a proportional hazards analysis, the corresponding crude relative risk (that is, the likelihood) for having any revascularization procedure for women compared with men was 0.67 (95% CI, 0.65 to 0.71). For PCI and CABG surgery, the corresponding relative risks were 0.77 (CI, 0.73 to 0.82) and 0.54 (0.51 to 0.58), respectively. Thus, in relative terms, women were 33% less likely to undergo any revascularization procedure, 23% less likely to undergo PCI, and 46% less likely to undergo CABG surgery than were men.

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Figure 1.
Relative risks for undergoing revascularization procedures in women compared with men.
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Figure 2.
Crude (unadjusted) and fully adjusted cumulative revascularization curves for men and women.A.B.PCIC.CABG

Curves for any revascularization procedure. Curves for percutaneous coronary intervention ( ). Curves for coronary artery bypass graft ( ).

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Summary for Patients

Clinical Factors Explain Differences in Frequency of Cardiac Procedures between Men and Women after Cardiac Catheterization

The summary below is from the full report titled “Sex Differences in Access to Coronary Revascularization after Cardiac Catheterization: Importance of Detailed Clinical Data.” It is in the 21 May 2002 issue of Annals of Internal Medicine (volume 136, pages 723-732). The authors are WA Ghali, PD Faris, PD Galbraith, CM Norris, MJ Curtis, LD Saunders, V Dzavik, LB Mitchell, and ML Knudtson, for the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) Investigators.

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