Interaction of Operator−Patient Sex on Peri‐Procedural Treatments and Major Coronary Outcomes After Percutaneous Coronary Intervention

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