Mechanical complications of acute myocardial infarction are infrequent in the modern era of primary percutaneous coronary intervention, but they are associated with high mortality rates. Papillary muscle rupture with acute severe mitral regurgitation is one such life-threatening complication that requires early detection and urgent surgical intervention. ( Level of Difficulty: Beginner. )

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Objectives To examine the association of operator sex with appropriateness and outcomes of percutaneous coronary intervention (PCI). Background Recent studies suggest that physician sex may impact outcomes for specific patient cohorts. There are no data evaluating the impact of operator sex on PCI outcomes. Methods We studied the impact of operator sex on PCI outcome and appropriateness among all patients undergoing PCI between January 2010 and December 2017 at 48 non‐federal hospitals in Michigan. We used logistic regression models to adjust for baseline risk among patients treated by male versus female operators in the primary analysis. Results During this time, 18 female interventionalists and 385 male interventionalists had performed at least one PCI. Female interventionalists performed 6362 (2.7%) of 239,420 cases. There were no differences in the odds of mortality (1.48% vs. 1.56%, adjusted OR [aOR] 1.138, 95% CI: 0.891–1.452), acute kidney injury (3.42% vs. 3.28%, aOR 1.027, 95% CI: 0.819–1.288), transfusion (2.59% vs. 2.85%, aOR 1.168, 95% CI: 0.980–1.390) or major bleeding (0.95% vs. 1.07%, aOR 1.083, 95% CI: 0.825–1.420) between patients treated by female versus male interventionalist. While the absolute differences were small, PCIs performed by female interventional cardiologists were more frequently rated as appropriate (86.64% vs. 84.45%, p‐value <0.0001). Female interventional cardiologists more frequently prescribed guideline‐directed medical therapy. Conclusions We found no significant differences in risk‐adjusted in‐hospital outcomes between PCIs performed by female versus male interventional cardiologists in Michigan. Female interventional cardiologists more frequently performed PCI rated as appropriate and had a higher likelihood of prescribing guideline‐directed medical therapy.

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