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日本介入心脏病学中的性别差异:女性操作者在经皮冠状动脉介入治疗中的结果

Gender Disparities in Japanese Interventional Cardiology: Outcomes of Female Operators in Percutaneous Coronary Interventions.

作者信息

Takahashi Saeko, Yamaji Kyohei, Kohsaka Shun, Hayashida Kyoko, Sato Junko, Tsukahara Reiko, Honye Junko, Amano Tetsuya, Kozuma Ken

机构信息

Department of Cardiology, Shonan Oiso Hospital, Oiso, Japan.

Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan.

出版信息

JACC Asia. 2024 Aug 20;4(9):674-683. doi: 10.1016/j.jacasi.2024.07.005. eCollection 2024 Sep.

DOI:10.1016/j.jacasi.2024.07.005
PMID:39371622
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11450856/
Abstract

BACKGROUND

Gender disparity remains a significant global concern in interventional cardiology, and there is a lack of extensive research examining the outcomes of percutaneous coronary interventions (PCIs) performed by female interventionalists.

OBJECTIVES

The aim of this study was to examine the practice patterns and outcomes of PCIs conducted by female interventionalists in Japan.

METHODS

This retrospective observational study analyzed data from the Japanese Percutaneous Coronary Intervention registry between January 2019 and December 2021. The primary endpoint was in-hospital mortality and the secondary endpoint was the success rate of PCIs.

RESULTS

A total of 447 female operators (7.3% of all operators) performed 35,211 PCIs (5.3%) during the study period. Female doctors treated a higher percentage of patients with ST-segment elevation myocardial infarction compared with their male counterparts (20.2% vs 17.7%;  = 0.001), whereas male doctors were more likely to perform PCIs for left main disease (4.9% vs 5.9%;  < 0.001) and lesions treated with rotational atherectomy (3.5% vs 4.9%;  < 0.001). The success rate of PCIs was higher for female interventionalists (97.8% vs 97.2%;  < 0.001). After conducting a risk-adjusted analysis, we found no significant difference in in-hospital mortality (adjusted OR: 0.896; 95% CI: 0.78-1.03;  = 0.12), or procedural complications associated with the operator's gender.

CONCLUSIONS

Overall, female operators exhibited outcomes similar to their male counterparts in terms of adjusted procedural outcomes, and higher crude success rate in certain subgroups. These findings emphasize gender disparities and stress the need to increase gender diversity in interventional cardiology.

摘要

背景

性别差异仍是全球介入心脏病学领域的一个重大问题,目前缺乏对女性介入专家进行经皮冠状动脉介入治疗(PCI)结果的广泛研究。

目的

本研究旨在探讨日本女性介入专家进行PCI的实践模式和结果。

方法

这项回顾性观察研究分析了2019年1月至2021年12月期间日本经皮冠状动脉介入治疗注册中心的数据。主要终点是住院死亡率,次要终点是PCI成功率。

结果

在研究期间,共有447名女性操作者(占所有操作者的7.3%)进行了35211例PCI(占5.3%)。与男性医生相比,女性医生治疗ST段抬高型心肌梗死患者的比例更高(20.2%对17.7%;P = 0.001),而男性医生更有可能对左主干病变进行PCI(4.9%对5.9%;P < 0.001)以及对采用旋磨术治疗的病变进行PCI(3.5%对4.9%;P < 0.001)。女性介入专家的PCI成功率更高(97.8%对97.2%;P < 0.001)。在进行风险调整分析后,我们发现住院死亡率(调整后的OR:0.896;95%CI:0.78 - 1.03;P = 0.12)或与操作者性别相关的手术并发症没有显著差异。

结论

总体而言,在调整后的手术结果方面,女性操作者的表现与男性操作者相似,并且在某些亚组中的粗成功率更高。这些发现强调了性别差异,并强调了在介入心脏病学领域增加性别多样性的必要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a3e/11450856/296bf8c0f163/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a3e/11450856/296bf8c0f163/ga1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a3e/11450856/c27016c4acf7/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a3e/11450856/85f791d47012/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a3e/11450856/296bf8c0f163/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a3e/11450856/296bf8c0f163/ga1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a3e/11450856/c27016c4acf7/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a3e/11450856/85f791d47012/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a3e/11450856/296bf8c0f163/gr3.jpg

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本文引用的文献

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Lancet Reg Health West Pac. 2022 Mar 22;22:100434. doi: 10.1016/j.lanwpc.2022.100434. eCollection 2022 May.
2
Japanese Nationwide PCI (J-PCI) Registry Annual Report 2019: patient demographics and in-hospital outcomes.《2019年日本全国经皮冠状动脉介入治疗(J-PCI)注册报告:患者人口统计学特征及院内结局》
Cardiovasc Interv Ther. 2022 Apr;37(2):243-247. doi: 10.1007/s12928-021-00832-0. Epub 2022 Jan 12.
3
Association of Surgeon-Patient Sex Concordance With Postoperative Outcomes.
外科医生与患者性别一致性与术后结果的关联。
JAMA Surg. 2022 Feb 1;157(2):146-156. doi: 10.1001/jamasurg.2021.6339.
4
The DISCO study-Does Interventionalists' Sex impact Coronary Outcomes?DISCO 研究——介入医生的性别是否会影响冠状动脉结局?
Catheter Cardiovasc Interv. 2021 Oct;98(4):E531-E539. doi: 10.1002/ccd.29774. Epub 2021 May 17.
5
Does Patient-Physician Gender Concordance Influence Patient Perceptions or Outcomes?医患性别一致性会影响患者的认知或治疗结果吗?
J Am Coll Cardiol. 2021 Mar 2;77(8):1135-1138. doi: 10.1016/j.jacc.2020.12.031.
6
A Paucity of Female Interventional Cardiologists: What Are the Issues and How Can We Increase Recruitment and Retention of Women?女性介入心脏病专家数量不足:问题何在以及我们如何增加女性从业者的招募与留存?
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