TY - JOUR
T1 - Sex-specific differences in potent P2Y12 inhibitor use in British Cardiovascular Intervention Society registry STEMI patients
AU - Burgess , Sonya
AU - Shoaib, Ahmad
AU - Sharp, Andrew
AU - Ludman, Peter
AU - Graham, Michelle M.
AU - Figtree, Gemma A
AU - Kontopantelis, Evangelos
AU - Rashid, Muhammad
AU - Kinnaird, Tim
PY - 2023/9/19
Y1 - 2023/9/19
N2 - 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.
AB - 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.
KW - Male
KW - Humans
KW - Female
KW - Clopidogrel
KW - Prasugrel Hydrochloride/adverse effects
KW - ST Elevation Myocardial Infarction/diagnosis
KW - Ticagrelor/adverse effects
KW - Treatment Outcome
KW - Registries
U2 - 10.1161/CIRCINTERVENTIONS.122.012447
DO - 10.1161/CIRCINTERVENTIONS.122.012447
M3 - Article
C2 - 37725676
SN - 1941-7640
VL - 16
JO - Circulation: Cardiovascular Interventions
JF - Circulation: Cardiovascular Interventions
IS - 9
M1 - e012447
ER -