Other factors may still play a role in the observed differences between the sexes. Women may be more likely to have surgery on an outpatient basis after discharge from the hospital. Our study did not investigate this possibility. Women may need more time to decide whether they want to undergo surgery, thereby delaying a procedure. Another possibility is that the age of women who are having an MI is greater than that of men having an MI; women may therefore refuse surgery more often than men because of their age. The research has not examined whether women tend to refuse or delay these procedures more often than men. Further research should be done in this area, including outpatient procedures, women’s views on surgery, and other potential barriers to surgery.
The current study has several limitations. For example, data regarding congestive heart failure (CHF) was not available for inclusion in the analysis. Previous studies found that CHF was more common in women than in men. In addition, comorbidities were analyzed as dichotomous variables. Data on the severity of preexisting conditions could not be assessed. The study lacks any data on the severity of illness during hospitalization. The sample size was smaller than that of some previous work in this area. Finally, we lacked data on the number of vessels involved for all patients in the study. Therefore, it is possible that women had an equal risk of 3-vessel and left main coronary disease, but were not referred for CABG.
Conclusions
After being admitted for an acute MI, men and women had no significant difference in mortality, time spent in the ICU, total time in the hospital, frequency of stent placement, angiograms, or angioplasty. Men, however, had a significantly higher rate of CABG. Among those undergoing bypass surgery, men had significantly more advanced left-main coronary disease and 3-vessel disease than women. Controlling for the extent of coronary artery disease eliminated any bias for sex in the number of CABGs performed.