Abstract 15670: Temporal Effect On Gender Differences In Patients Undergoing Evaluation For Coronary Artery Disease
Background: Gender bias has influenced treatment and referral practices in patients with suspected coronary artery disease (CAD), but may be reduced with increasing awareness of the impact of CAD in women.
Methods: Gender and temporal trends influencing referral for cardiac catheterization (cath) after stress testing was explored in a large university hospital. All patients referred for ischemia evaluation using nuclear stress were included.. Predictors of referral to cath were determined using multiple logistic regression. Differences in long-term all-cause mortality were tested using the Kaplan-Meier survival curve method with log-rank test.
Results: Between 1995-2008, 22462 patients (47% female) underwent stress myocardial perfusion imaging (MPI) for ischemic evaluation. The mean age of men and women referred for stress testing increased significantly over time (from 56 to 60 for men, and 59 to 62 for women; p<0.01). Women were more likely to undergo a pharmacologic stress test, the use of which increased over time in both genders. Women were less likely to be referred for cath but gender was NOT a predictor for cath (OR=0.93, p=0.13). The risk of death was greatest in women with a positive stress test who were not referred for cath compared with those with a normal stress test (HR=1.45,p<0.01) but mortality did not differ by gender when a positive stress test occurred, regardless of cath (p=NS).
Conclusions: In this large cohort of patients referred for ischemic evaluation, gender does not influence referral for cath. In addition, cath does not appear to influence survival. Rather than underutilization of cath in women, this may reflect a correct utilization of cath being applied by the physician determining need for cath. These findings have important implications for clinical practice and health policy.
- © 2011 by American Heart Association, Inc.