Sex Differences in Outcome and Prescribing Practice in ST-elevation MI Patients with Multivessel Disease and
Sonya Burgess1,2,3,4, Craig P Juergens1,2, Wesley Yang1
1Cardiology Department, Ingham Institute at Liverpool Hospital Sydney, Australia.
European Cardiology
|July 5, 2023
Summary
Sex disparities in ST-elevation myocardial infarction (STEMI) persist, with women experiencing higher cardiac death and MI rates. Multivessel disease and underprescribing of P2Y12 inhibitors in women contribute to these poorer outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Outcomes Research
Background:
- Sex-based outcome disparities exist in ST-elevation myocardial infarction (STEMI) patients.
- Multivessel disease (MVD) and incomplete revascularization are common challenges.
- Understanding factors contributing to outcome differences is crucial for improving patient care.
Purpose of the Study:
- To quantify the impact of MVD, incomplete revascularization, and prescribing patterns on sex-based outcome differences in STEMI patients.
- To determine if cardiac death and MI (CDMI) rate disparities persist at long-term follow-up.
Main Methods:
- Observational study of 2,083 consecutive STEMI patients undergoing percutaneous coronary intervention.
- Analysis of sex-based differences in MVD, residual SYNTAX score (rSS), and CDMI rates.
- Multivariable analysis to identify independent predictors of CDMI, including sex and MVD.
Main Results:
- Women (20.3%) had higher CDMI rates (20.3%) than men (13.2%) (p=0.028), persisting after risk adjustment (aHR 1.33).
- Women with MVD experienced disproportionately higher CDMI rates (p<0.001).
- Women received guideline-recommended P2Y12 inhibitors less often than men (31% vs. 43%, p=0.012), especially those with MVD (25% vs. 45%, p=0.011).
Conclusions:
- Sex-based outcome disparities in STEMI patients persist long-term, particularly for women with MVD.
- Incomplete revascularization and suboptimal P2Y12 inhibitor prescribing in women may exacerbate poor outcomes.
- Addressing these disparities is essential for equitable STEMI patient care.
Keywords:
Antiplatelet therapyMIcardiac deathincomplete revascularisationmultivessel coronary artery diseasewomenMore Related Videos
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