Why the study?
Women with MI undergoing invasive angiography have higher morbidity and mortality than men, and sex-based treatment bias in optimal medical therapy has been shown historically.
Are there sex differences in the prescribing of optimal medical therapy following invasive angiography for obstructive CAD?
Observational (n=10,591)
No
Are there sex differences in the prescribing of optimal medical therapy following invasive angiography for obstructive CAD?
While women with obstructive CAD historically receive less optimal medical therapy than men post-angiography, prescribing practices for women have shown significant improvements over time.
Women who experience myocardial infarction (MI) and undergo invasive angiography, experience higher morbidity and mortality compared to age-matched male counterparts. The prognostic benefit of optimal medical therapy (OMT) following MI is well established, however treatment bias has been evidenced historically between the sexes. We explored sex differences in prescribing trends of OMT following invasive angiography for obstructive CAD at a high throughput regional cardiac centre. We determined discharge medication received by females and males undergoing invasive angiography in 2017, 2019, 2022 and 2024 with obstructive CAD (angiographic lesion ≥50% luminal diameter). Logistic regression was used to determine differences in the main cohort and in sub-groups by clinical diagnosis (ACS, STEMI, NSTEMI, stable angina) and age (< 55 or ≥55 years). This latter age cut-off to explore pre and post-menopause trends, respectively. 10,591 patient attendances (22.3% female, n=2,360) were included in the analysis. In the overall cohort women were less likely to receive β-blockers (P=0.002), ACE-I/ARB (P=0.002) and high potency P2Y12 inhibitors (P<0.001) compared to males. In ACS similar patterns were observed for β-blockers and high potency P2Y12 inhibitors, women ≥55 years were less likely to receive high intensity statin (HIS). However, we show significant improvements in the prescribing of β-blockers (P=0.018) in women over time, and a trend towards improved prescribing of high potency P2Y12 inhibitors (P=0.085) in ACS. These findings demonstrate welcome improvements in equitable prescribing practices for OMT post angiography and highlight the importance of reviewing prescribing practices to ensure evidencing of success in implementing best practice guidelines.
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Sullivan et al. (2026) conducted an observational in Obstructive coronary artery disease (n=10,591). Female sex vs. Male sex was evaluated on Receipt of optimal medical therapy (β-blockers, ACE-I/ARB, and high potency P2Y12 inhibitors) at discharge (p=0.002).
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