Operator sex does not impact PCI outcomes
Among interventional cardiologists, operator sex did not influence risk-adjusted mortality or morbidity, although female operators scored higher on appropriateness metrics and prescribed more guideline-directed medical therapy.
“While overall, both male and female operators provided excellent care, the female operators were ahead,” Hitinder S. Gurm, MBBS, associate chief clinical officer of University of Michigan, told Healio.
The Michigan-based study, published in Catheterization and Cardiovascular Interventions, also found that female interventional cardiologists were scarce, performing a small percentage of PCI cases in the state, a disparity Gurm called both “striking” and “disconcerting.”
According to Gurm, a couple of recent studies showed that outcomes were better when patients were treated by female physicians, and that female patients did better when treated by female physicians. “We wanted to see whether the same held true for interventional cardiology,” he said.
To better understand the association between operator sex and appropriateness and outcomes of PCI, Gurm and colleagues examined all patients undergoing the procedure from 2010 to 2017 at 48 nonfederal hospitals in Michigan. They used the CMS full replacement National Provider Identifier file to determine operator sex.
In all, 18 female interventional cardiologists and 385 male interventional cardiologists performed at least one PCI, with female operators performing 2.7% of the cases.
No differences between groups were reported in the following patient outcomes:
mortality: 1.48% for female operators vs. 1.56% for male operators (adjusted OR = 1.138; 95% CI, 0.891-1.452);
acute kidney injury: 3.42% for female operators vs. 3.28% for male operators (aOR = 1.027; 95% CI, 0.819-1.288);
transfusion: 2.59% for female operators vs. 2.85% for male operators (aOR = 1.168; 95% CI, 0.98-1.39); and
major bleeding: 0.95% for female operators vs. 1.07% for male operators (aOR = 1.083; 95% CI, 0.825-1.42).
In addition, female interventional cardiologists more frequently performed PCI rated as appropriate (P < .0001) and prescribed guideline-directed medical therapy (P < .0001 for statins; P = .0009 for aspirin; P > .05 for other medications) — metrics that, according to Gurm, impact the value of PCI and long-term outcome of the patient.
Gurm further noted that most of the data were in line with his expectations before conducting the study, but he had not anticipated the proportion of female operators.
“It is embarrassing that the ratio of women to men in our field remains so low in 2021,” he said. “I hope that these findings will push our professional societies and training programs to develop strategies to encourage future female trainees to pursue a career in interventional cardiology.”
For more information:
Hitinder S. Gurm, MBBS, can be reached at firstname.lastname@example.org.