Key result
Women with STEMI have ~4% lower odds of receiving potent P2Y12 inhibitors and higher mortality.
Why the study?
Sex-based outcome differences for women with STEMI have not been adequately addressed, and the role played by differences in potent P2Y12 inhibitor prescription is not well defined.
Does the differential use of potent P2Y12 inhibitors and radial access contribute to sex-based disparities in in-hospital mortality among STEMI patients?
Observational (n=168,818)
Yes
Does the differential use of potent P2Y12 inhibitors and radial access contribute to sex-based disparities in in-hospital mortality among STEMI patients?
Odds Ratio: 0.957 (95% CI 0.935–0.979)
Absolute Event Rate: 51.71% vs 55.18%
p-value: p=<0.001
Women with STEMI experience higher in-hospital mortality than men, a disparity that is associated with lower utilization of radial access and potent P2Y12 inhibitors.
Observed sex differences in P2Y12 inhibitor use and STEMI mortality may reflect procedural factors; hypothesis-generating and should not yet change practice.
BACKGROUND: Sex-based outcome differences for women with ST-segment–elevation myocardial infarction (STEMI) have not been adequately addressed, and the role played by differences in prescription of potent P2Y 12 inhibitors (P-P2Y 12 ) is not well defined. This study explores the hypothesis that disparities in P-P2Y 12 (prasugrel or ticagrelor) use may play a role in outcome disparities for women with STEMI. METHODS: Data from British Cardiovascular Intervention Society national percutaneous coronary intervention database were analyzed, and 168 818 STEMI patients treated with primary percutaneous coronary intervention from 2010 to 2020 were included. RESULTS: Among the included women (43 131; 25.54%) and men (125 687; 74.45%), P-P2Y 12 inhibitors were prescribed less often to women (51.71%) than men (55.18%; P <0.001). Women were more likely to die in hospital than men (adjusted odds ratio, 1.213 [95% CI, 1.141–1.290]). Unadjusted mortality was higher among women treated with clopidogrel (7.57%), than P-P2Y 12 -treated women (5.39%), men treated with clopidogrel (4.60%), and P-P2Y 12 -treated men (3.61%; P <0.001). The strongest independent predictor of P-P2Y 12 prescription was radial access (adjusted odds ratio, 2.368 [95% CI, 2.312–2.425]), used in 67.93% of women and 74.38% of men ( P <0.001). Two risk adjustment models were used. Women were less likely to receive a P-P2Y 12 (adjusted odds ratio, 0.957 [95% CI, 0.935–0.979]) with risk adjustment for baseline characteristics alone, when procedural factors including radial access were included in the model differences were not significant (adjusted odds ratio, 1.015 [95% CI, 0.991–1.039]). CONCLUSIONS: Women were less likely to be prescribed prasugrel or ticagrelor, were less likely to have radial access, and had a higher mortality when being treated for STEMI. Improving rates of P-P2Y 12 use and radial access may decrease outcome disparities for women with STEMI.
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Burgess et al. (2023) conducted an observational in ST-segment-elevation myocardial infarction (STEMI) (n=168,818). Female sex vs. Male sex was evaluated on Prescription of potent P2Y12 inhibitors (prasugrel or ticagrelor) (OR 0.957, 95% CI 0.935-0.979, p=<0.001). Women with STEMI were less likely to be prescribed potent P2Y12 inhibitors than men (51.71% vs 55.18%; adjusted OR 0.957, 95% CI 0.935-0.979) and had higher adjusted in-hospital mortality.
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