Sex differences in access to coronary revascularization after cardiac catheterization: Importance of detailed clinical data
Sex differences in access to coronary revascularization after cardiac catheterization: Importance of detailed clinical data
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DOI：
10.7326/0003-4819-136-10-200205210-00007
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发表时间：
2002-05-21
影响因子：
39.2
通讯作者：
Knudtson, ML
中科院分区：
文献类型：
--
作者：
Ghali, WA;Faris, PD;Knudtson, ML
背景：虽然一些研究表明接受心脏手术的性别不同，但其他研究没有发现心脏护理中存在性别偏见的证据。目的：研究心脏插管后男性和女性经皮冠状动脉介入(PCI)或冠状动脉旁路移植术(CABG)的发生率。设计：前瞻性数据收集的队列研究。地点：加拿大艾伯塔省。患者：1995年1月1日至1998年12月31日期间接受心脏插管的患者(n=21 816)。测量：测量心脏插管后一年的血运重建手术(PC[或CAM])的发生率。未调整的血管重建率、部分调整的比率(根据大多数数据库，包括行政数据库中的临床变量进行调整)和完全调整的比率(另外还调整了冠状动脉病变程度和射血分数)也被评估。结果：女性任何血管重建终点相对于男性的未调整相对危险度为0.67(95%CI，0.65至0.71)。部分调整后的相对风险增加到0.69(CI，0.66~0.72)，完全调整后的相对风险增加到0.98(CI，0.94~1.03)，这表明男性和女性获得血运重建的机会相同。冠状动脉介入治疗的相对危险度分别为0.77(CI，0.73~0.82)、0.84(C)、0.80~0.89和1.02(CI，0.96~1.08)。冠状动脉旁路移植术的相对危险度分别为0.54(CI，0.51~0.58)、0.51(CI，0.48~0.55)和0.93(CI，0.87~1.01)。结论：在加拿大艾伯塔省，临床变量充分解释了心导管术后血运重建率的性别差异，如果不完全调整男女之间的临床差异，就会得出误导性的结论。在解释使用稀少详细临床数据来源的获得护理的报告时，需要极其谨慎。
Background: Although some studies suggest that access to cardiac procedures may differ by sex, others have found no evidence of gender bias in cardiac care.Objective: To study rates of percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery in men and women after cardiac catheterization.Design: Cohort study with prospective data collection.Setting: Alberta, Canada.Patients: Persons undergoing cardiac catheterization between I January 1995 and 31 December 1998 (n = 21 816).Measurements: The occurrence of revascularization procedures (PC[ or CAM in the year after cardiac catheterization was measured. Unadjusted revascularization rates, partially adjusted rates (adjusted for clinical variables available in most databases, including administrative databases), and fully adjusted rates (additionally adjusted for extent of coronary artery disease and ejection fraction) were also evaluated.Results: The unadjusted relative risk was 0.67 (95% Cl, 0.65 to 0.71) for the end point of any revascularization in women relative to men. The relative risk increased to 0.69 (Cl, 0.66 to 0.72) with partial adjustment and to 0.98 (Cl, 0.94 to 1.03) with full adjustment, indicating equivalent access to revascularization for men and women. For PCI, the corresponding relative risks were 0.77 (Cl, 0.73 to 0.82), 0.84 (C], 0.80 to 0.89), and 1.02 (Cl, 0.96 to 1.08). For CABG surgery, the relative risks were 0.54 (Cl, 0.51 to 0.58), 0.51 (Cl, 0.48 to 0.55), and 0.93 (Cl, 0.87 to 1.01).Conclusions: In Alberta, Canada, clinical variables fully explain sex differences in rates of revascularization after cardiac catheterization, and misleading conclusions would arise without full adjustment for clinical differences between men and women. Extreme caution is needed in interpreting reports on access to care that use sparsely detailed clinical data sources.