The DISCO study—Does Interventionalists' Sex impact Coronary Outcomes?

Abstract

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.

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

“…The overall occurrence of allergic reactions in men was low and this finding could be due to chance alone. Our findings are largely in line with the Blue Cross Blue Shield of Michigan Cardiovascular Consortium’s DISCO study [ 17 ]. Similar to our study, a minority of PCI operators were women (4.5%) performing only 2.66% of all PCIs.…”

“…The previous analysis of the ORPKI registry has confirmed similar practice patterns and outcomes of PCIs performed by female as compared to male operators [ 19 ]. Similarly, in the DISCO study, no differences in in-hospital mortality were found between patients treated by male or female interventional cardiologists [ 17 ]. Interestingly, PCIs performed by female physicians were more frequently rated as appropriate as compared to procedures performed by their male counterparts.…”

“…Interestingly, PCIs performed by female physicians were more frequently rated as appropriate as compared to procedures performed by their male counterparts. In addition, female interventional cardiologists more frequently prescribed recommended medical therapies than male interventional cardiologists [ 17 ].…”

Women in interventional cardiology – patients’ and operators’ perspectives

“…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 ].…”

Women in Interventional Pulmonology: Results from a Worldwide Survey

“…Women are also underrepresented in the field of interventional radiology [13]. Similar results have been observed in interventional cardiology: The DISCO [14] study that examined the outcome and appropriateness of percutaneous coronary intervention by gender showed that over a 7-year period only 4.5% of the interventionalists were women, performing only 2.8% of all procedures. This was despite the fact that the outcome of the interventions was the same for women and men, and no differences were obtained regarding in-hospital mortality or complications.…”