Interaction of Operator-Patient Sex on Peri-Procedural Treatments and Major Coronary Outcomes After Percutaneous...

There are limited data evaluating the association between operator-patient sex, and outcomes in patients undergoing percutaneous coronary intervention (PCI).

We included 138,112 consecutive PCI procedures in patients presenting with acute coronary syndrome (ACS) in England and Wales, 2017-2020. Primary endpoints of in-hospital major adverse cardiovascular and cerebrovascular events (MACCE), and mortality were assessed. Risk ratios (RR) estimated independent associations of patient sex and patient-operator sex with peri-procedural treatment and outcomes.

Female patients had a 10% higher risk of MACCE [95% CI: 1.04, 1.16], and a 14% higher risk of in-hospital mortality than male patients [95% CI: 1.07, 1.21]. Male operators undertook the vast majority of PCI procedures; 130,604 (94.6%). Patient sex-based differences in outcomes were not present for female operators but were statistically significant amongst male operators. Risk-adjusted data found that, when treated by male operators, female patients experienced higher MACCE and mortality rates than male patients (4.1% vs. 3.7%; RR: 1.11 [95% CI: 1.05,1.18] and 3.1% vs. 2.7%; RR: 1.15 [95% CI: 1.08, 1.22] respectively). When treated by female operators, female patients experienced numerically lower MACCE rates than male patients (4.0% vs. 4.3%; RR:0.93 [95% CI: 0.72, 1.14] and similar mortality rates (2.9% vs. 2.9%; RR:1.01 [95% CI: 0.75, 1.26]). Operator-patient sex discordance was associated with lower transradial PCI (RR: 0.96 [95% CI: 0.95, 0.96]), lower prasugrel use (RR: 0.88 [95% CI: 0.82, 0.94]), higher MACCE (RR: 1.12 [95% CI: 1.06, 1.18]) and mortality (RR: 1.14 [95% CI: 1.07,1.21]) compared with operator-patient sex concordance.

Female patients experienced higher risk-adjusted mortality than male patients; while outcomes appeared less favorable among those treated by male operators, this finding should be interpreted cautiously given the limited precision for female operators.