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Compared with LITA+SVG, MAG is associated with reduced mortality, repeated revascularization, myocardial infarction, and heart failure among patients with multivessel disease who are undergoing coronary artery bypass grafting without increased mortality or other adverse events at 30 days. The long-term benefits consistently observed across multiple outcomes and subgroups support the consideration of MAG for a broader spectrum of patients who are undergoing coronary artery bypass grafting in routine practice.

The 30-day mortality after CABG decreased significantly between 1991 and 2004, especially in women, suggesting that the gender difference in short-term outcomes is diminishing. The overall 42% higher mortality risk in women seems to be partially mediated through body surface area, a surrogate for vessel size.

S tudies published before 1999 have reported sex differences in cardiovascular procedure rates following an acute myocardial infarction (AMI). Specifically, women underwent coronary catheterization and revascularization less frequently than men (1-6). Age-adjusted mortality rates were significantly higher in women (4-6). After 1999, several trials were published demonstrating improved outcomes in patients receiving an early invasive strategy (coronary catheterization with or without percutaneous coronary intervention [PCI]) compared with a conservative approach following non-ST elevation myocardial infarction (NSTEMI) (7-9). In addition, the American College of Cardiology/American Heart Association (ACC/AHA) guidelines for the management of patients with NSTEMI emphasized an early invasive approach in both men and women (10).It is unknown whether sex differences in cardiac procedure rates post-AMI persist in the era emphasizing an early invasive strategy. We sought to examine trends in catheterization and revascularization rates following an AMI in British Columbia (BC) from 1994 to 2003. Specifically, we examined the effect of sex on receiving catheterization and revascularization adjusted for potential confounders. BACkground: Studies before the turn of the century reported sex differences in procedure rates. It is unknown whether these differences persist. oBJECTivES: To examine time trends and sex differences in coronary catheterization and revascularization following acute myocardial infarction (AMI). METhodS: A retrospective analysis was performed of all patients 20 years of age or older who were admitted to hospital in British Columbia with an AMI between April 1, 1994, and March 31, 2003. Segmented regression analysis was used to examine the inflection point of the time trend in 90-day catheterization rates post-AMI. Multivariable Cox regression modelling was used to evaluate sex differences in receiving catheterization and revascularization following AMI. rESuLTS: Ninety-day coronary catheterization rates increased significantly over the study period for both men and women (P<0.0001 for trend), with a steeper increase beginning in September 2000. Women were less likely to undergo catheterization than men, even after adjustment for baseline differences; this sex effect was modified by age and care in the intensive care unit or cardiac care unit (ICU/CCU). Specifically, ICU/CCU admission eliminated the sex difference among patients who were younger than 65 years of age. Conditional on receiving cardiac catheterization post-AMI, female sex was not associated with a lower likelihood of receiving revascularization within one year (HR 0.96; 95% CI 0.91 to 1.02). ConCLuSionS: Despite recent increases in catheterization rates post-AMI, women were less likely to undergo catheterization than men. Interestingly, access to ICU/CCU care removed the sex difference in catheterization access in patients younger than 65 years of age.

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