Sex-Specific Differences in Potent P2Y12 Inhibitor Use in British Cardiovascular Intervention Society Registry STEMI
Sonya N Burgess1,2, Ahmad Shoaib3,4,5,6, Andrew S P Sharp7
1Department of Cardiology, Nepean Hospital, Sydney, Australia (S.N.B.).
Insights
Women with ST-elevation myocardial infarction (STEMI) receive fewer potent P2Y12 inhibitors and have higher mortality. Improving access to these drugs and radial access may reduce outcome disparities for female STEMI patients.
Area of Science:
- Cardiology
- Clinical Medicine
- Interventional Cardiology
Background:
- Sex-based outcome differences in ST-segment-elevation myocardial infarction (STEMI) are not fully understood.
- The role of potent P2Y12 inhibitors (prasugrel or ticagrelor) in these disparities requires further definition.
Purpose of the Study:
- To investigate if disparities in potent P2Y12 inhibitor (P-P2Y12) use contribute to outcome differences in women with STEMI.
- To examine the association between P-P2Y12 prescription, radial access, and in-hospital mortality in STEMI patients.
Main Methods:
- Analysis of the British Cardiovascular Intervention Society national percutaneous coronary intervention database.
- Inclusion of 168,818 STEMI patients treated with primary percutaneous coronary intervention from 2010 to 2020.
- Comparison of P-P2Y12 inhibitor use, radial access rates, and in-hospital mortality between men and women, with risk adjustment.
Main Results:
- Women (25.54%) received P-P2Y12 inhibitors less often than men (51.71% vs. 55.18%; P<0.001).
- Women had higher in-hospital mortality (adjusted OR, 1.213) and were less likely to receive P-P2Y12 inhibitors.
- Radial access, a predictor of P-P2Y12 use, was less frequent in women (67.93% vs. 74.38%).
Conclusions:
- Women with STEMI are less likely to be prescribed potent P2Y12 inhibitors and have lower rates of radial access, correlating with higher mortality.
- Strategies to improve P-P2Y12 inhibitor and radial access rates in women may help reduce outcome disparities in STEMI.
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.
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