SEX BIAS IN CONSIDERING CORONARY-BYPASS SURGERY
SEX BIAS IN CONSIDERING CORONARY-BYPASS SURGERY
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DOI：
10.7326/0003-4819-107-1-19
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发表时间：
1987-07-01
影响因子：
39.2
通讯作者：
WACHSPRESS, J
中科院分区：
文献类型：
--
作者：
TOBIN, JN;WASSERTHEILSMOLLER, S;WACHSPRESS, J
心血管核医学运动研究可以作为一种筛选方法，用于做出转诊患者进行导管插入术和冠状动脉搭桥手术的决定。在一项对 390 名连续转诊进行核运动测试的患者进行的研究中，31% 的女性和 64% 的男性发现异常结果，这影响了医生仅建议男性进行导管插入术的决定；放射性核素扫描异常的女性中有 4% 被转诊接受导管插入术，而男性的这一比例为 40% (p < 0.001)。这个 10:1 的比例与年龄无关。控制年龄、既往心肌梗死、典型和非典型心绞痛的存在以及异常测试结果的多重逻辑回归分析得出男性的比值比为 6.3。心血管核扫描结果异常的冠心病患者男女比例仅为2:1。因此，转诊患者进行心导管插入术的决定中的性别差异不能完全用测试敏感性或冠状动脉疾病发生率的差异来解释。它也不能用手术的不同益处来解释。这些发现提出了一个问题：冠状动脉搭桥手术在女性中是否得到充分利用。
Cardiovascular nuclear medicine exercise studies may serve as a screening method to be used in making decisions to refer patients for catheterization and coronary artery bypass surgery. In a study of 390 patients consecutively referred for nuclear exercise testing, abnormal results found in 31% of the women and in 64% of the men affected physicians'' decisions to recommend catheterization in men only; 4% of the women with abnormal radionuclide scans were referred for catheterization compared with 40% of the men (p < 0.001). This 10:1 ratio was independent of age. A multiple logistic regression analysis that controlled for age, previous myocardial infarction, presence of typical and atypical angina, and abnormal test results yielded an odds ratio of 6.3 for men. The male-to-female ratio of patients with coronary artery disease given abnormal results of a cardiovascular nuclear scan is only 2:1. Thus, the sex differential in decisions to refer patients for cardiac catheterization cannot be explained entirely by differences in the sensitivity of tests or the rates of coronary artery disease; it also cannot be explained by differential benefits from surgery. These findings raise the question of whether coronary artery bypass surgery is underused in women.