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Sex-Specific Differences in Potent P2Y12 Inhibitor Use in British Cardiovascular Intervention Society Registry STEMI Patients

Burgess, Sonya N.; Shoaib, Ahmad; Sharp, Andrew S.P.; Ludman, Peter; Graham, Michelle M.; Figtree, Gemma A.; Kontopantelis, Evangelos; Rashid, Muhammad; Kinnaird, Tim; Mamas, Mamas A.

Authors

Sonya N. Burgess

Ahmad Shoaib

Andrew S.P. Sharp

Peter Ludman

Michelle M. Graham

Gemma A. Figtree

Evangelos Kontopantelis

Tim Kinnaird



Abstract

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 P2Y12 inhibitors (P-P2Y12) is not well defined. This study explores the hypothesis that disparities in P-P2Y12 (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-P2Y12 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-P2Y12-treated women (5.39%), men treated with clopidogrel (4.60%), and P-P2Y12-treated men (3.61%; P<0.001). The strongest independent predictor of P-P2Y12 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-P2Y12 (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-P2Y12 use and radial access may decrease outcome disparities for women with STEMI.

Journal Article Type Article
Acceptance Date Jul 25, 2023
Online Publication Date Sep 19, 2023
Publication Date Sep 29, 2023
Deposit Date Nov 7, 2023
Journal Circulation: Cardiovascular Interventions
Print ISSN 1941-7640
Electronic ISSN 1941-7632
Publisher American Heart Association
Peer Reviewed Peer Reviewed
Volume 16
Issue 9
DOI https://doi.org/10.1161/circinterventions.122.012447
Keywords Cardiology and Cardiovascular Medicine