Operator-patient sex discordance and periprocedural outcomes of percutaneous coronary intervention (from the ORPKI Polish National Registry)

Abstract

Introduction A recent study suggested that sex discordance between surgeons and patients negatively affects the outcomes of patients undergoing common surgical procedures. Aim We sought to assess whether such an impact exists for periprocedural outcomes of percutaneous coronary intervention (PCI). Material and methods From 2014 to 2020, data on 581,744 patients undergoing single-stage coronary angiography and PCI from 154 centers were collected. Patients were divided into four groups based on the patient and operator sex. Operator-patient sex discordance was defined as the procedure done by a male operator on a female patient or by a female operator on a male patient. Results Of 581,744 patients treated by 34 female and 782 male operators, 194,691 patients were sex discordant with their operator (female operator with male patient 12,479; male operator with female patient 182,212) while 387,053 were sex concordant (female operator with female patient 6,068; male operator with male patient 380,985). Among female patients, no difference in the risk of periprocedural complications, including death (0.65% vs. 0.82%; p = 0.10), between patients discordant versus concordant with operators was observed. Among male patients the risk of death (0.55% vs. 0.43%; p = 0.037) and bleeding at the puncture site (0.13% vs. 0.08%; p = 0.046) was higher in patients discordant with operators. However, the differences were no longer significant after adjustment for covariates. Conclusions No detrimental effect of operator-patient sex discordance on periprocedural outcomes was confirmed in all-comer patients undergoing PCI. Some of the observed differences in outcomes were primarily related to the differences in baseline risk profile.

Women in interventional cardiology – patients’ and operators’ perspectives

“…Similar results were obtained in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium’s DISCO study [ 14 ]. In this study, there were also no significant differences in outcomes: in-hospital mortality, acute kidney injury, transfusion or major bleeding among male and female patients undergoing PCIs performed by sex-concordant vs. sex-discordant operators [ 14 ]. Moreover, similarly to other studies, the DISCO study showed a small percentage of female PCI operators (4.5%), who performed only 2.66% of all PCIs [ 15 ].…”

“…Finally, such studies like the one presented by Dziewierz et al in this current issue support equality of IC operators in terms of sex [ 14 ]. The next challenge is to create the conditions for equal development and successful career in interventional cardiology.…”

“…In this issue of the journal, Dziewierz et al . illustrated the results of the data analysis from the Polish National Registry of PCI (ORPKI) showing the impact of the operator-patient sex discordance on periprocedural outcomes of PCI [ 14 ]. Of 581,744 patients treated by 34 female and 782 male operators, 194,691 patients were sex discordant with their operator (a female operator with a male patient: 12,479; a male operator with a female patient: 182,212) while 387,053 were sex concordant (a female operator with a female patient: 6,068; a male operator with a male patient: 380,985).…”