SEX-DIFFERENCES IN THE MANAGEMENT OF CORONARY-ARTERY DISEASE

被引:756
作者
STEINGART, RM
PACKER, M
HAMM, P
COGLIANESE, ME
GERSH, B
GELTMAN, EM
SOLLANO, J
KATZ, S
MOYE, L
BASTA, LL
LEWIS, SJ
GOTTLIEB, SS
BERNSTEIN, V
MCEWAN, P
JACOBSON, K
BROWN, EJ
KUKIN, ML
KANTROWITZ, NE
PFEFFER, MA
机构
[1] UNIV TEXAS, HLTH SCI CTR, HOUSTON, TX 77225 USA
[2] CUNY MT SINAI SCH MED, NEW YORK, NY 10029 USA
[3] MAYO CLIN & MAYO FDN, ROCHESTER, MN 55905 USA
[4] WASHINGTON UNIV, SCH MED, ST LOUIS, MO 63110 USA
[5] TULSA HEART CTR, TULSA, OK USA
[6] UNIV MARYLAND, BALTIMORE, MD 21201 USA
[7] UNIV BRITISH COLUMBIA, VANCOUVER V6T 1W5, BC, CANADA
[8] WELLESLEY COLL HOSP, TORONTO M4Y 1J3, ONTARIO, CANADA
[9] OREGON HEART INST, PORTLAND, OR USA
[10] SACRED HEART HOSP, EUGENE, OR USA
[11] SUNY STONY BROOK, STONY BROOK, NY 11794 USA
[12] BRIGHAM & WOMENS HOSP, BOSTON, MA 02115 USA
关键词
D O I
10.1056/NEJM199107253250402
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. Despite the fact that coronary artery disease is the leading cause of death among women, previous studies have suggested that physicians are less likely to pursue an aggressive approach to coronary artery disease in women than in men. To define this issue further, we compared the care previously received by men and women who were enrolled in a large postinfarction intervention trial. Methods. We assessed the nature and severity of anginal symptoms and the use of antianginal and anti-ischemic interventions before enrollment in the 1842 men and 389 women with left ventricular ejection fractions less-than-or-equal-to 40 percent after an acute myocardial infarction who were randomized in the Survival and Ventricular Enlargement trial. Results. Before their index infarction, women were as likely as men to have had angina and to have been treated with antianginal drugs. However, despite reports by women of symptoms consistent with greater functional disability from angina, fewer women had undergone cardiac catheterization (15.4 percent of women vs. 27.3 percent of men, P < 0.001) or coronary bypass surgery (5.9 percent of women vs. 12.7 percent of men, P < 0.001). When these differences were adjusted for important covariates, men were still twice as likely to undergo an invasive cardiac procedure as women, but bypass surgery was performed with equal frequency among the men and women who did undergo cardiac catheterization. Conclusions. Physicians pursue a less aggressive management approach to coronary disease in women than in men, despite greater cardiac disability in women.
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页码:226 / 230
页数:5
相关论文
共 22 条
[1]  
Eaker E D, 1989, Cardiovasc Clin, V19, P129
[2]  
FISHER LD, 1982, J THORAC CARDIOV SUR, V84, P334
[3]   PITFALLS IN THE SERIAL ASSESSMENT OF CARDIAC FUNCTIONAL STATUS - HOW A REDUCTION IN ORDINARY ACTIVITY MAY REDUCE THE APPARENT DEGREE OF CARDIAC COMPROMISE AND GIVE A MISLEADING IMPRESSION OF IMPROVEMENT [J].
GOLDMAN, L ;
COOK, EF ;
MITCHELL, N ;
FLATLEY, M ;
SHERMAN, H ;
COHN, PF .
JOURNAL OF CHRONIC DISEASES, 1982, 35 (10) :763-771
[4]   INVESTIGATION OF THE KARNOFSKY PERFORMANCE STATUS AS A MEASURE OF QUALITY OF LIFE [J].
GRIECO, A ;
LONG, CJ .
HEALTH PSYCHOLOGY, 1984, 3 (02) :129-142
[5]  
HILTS PJ, 1990, NY TIMES 0911, pC9
[6]   NONINVASIVE DIAGNOSTIC-TEST CHOICES FOR THE EVALUATION OF CORONARY-ARTERY DISEASE IN WOMEN - A MULTIVARIATE COMPARISON OF CARDIAC FLUOROSCOPY, EXERCISE ELECTROCARDIOGRAPHY AND EXERCISE THALLIUM MYOCARDIAL PERFUSION SCINTIGRAPHY [J].
HUNG, J ;
CHAITMAN, BR ;
LAM, J ;
LESPERANCE, J ;
DUPRAS, G ;
FINES, P ;
BOURASSA, MG .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1984, 4 (01) :8-16
[7]   NATURAL-HISTORY OF ANGINA-PECTORIS IN FRAMINGHAM STUDY - PROGNOSIS AND SURVIVAL [J].
KANNEL, WB ;
FEINLEIB, M .
AMERICAN JOURNAL OF CARDIOLOGY, 1972, 29 (02) :154-&
[8]  
KANNEL WB, 1987, CORONARY HEART DISEA, P208
[9]   CLINICAL AND ANGIOGRAPHIC PREDICTORS OF OPERATIVE MORTALITY FROM THE COLLABORATIVE STUDY IN CORONARY-ARTERY SURGERY (CASS) [J].
KENNEDY, JW ;
KAISER, GC ;
FISHER, LD ;
FRITZ, JK ;
MYERS, W ;
MUDD, JG ;
RYAN, TJ .
CIRCULATION, 1981, 63 (04) :793-802
[10]   INCREASED MORTALITY OF WOMEN IN CORONARY-ARTERY BYPASS-SURGERY - EVIDENCE FOR REFERRAL BIAS [J].
KHAN, SS ;
NESSIM, S ;
GRAY, R ;
CZER, LS ;
CHAUX, A ;
MATLOFF, J .
ANNALS OF INTERNAL MEDICINE, 1990, 112 (08) :561-567