Sex Differences in the Prescription of P2Y12 Inhibitor Agents Following Percutaneous Coronary Intervention

Gender disparities persist in cardiovascular care, including in the use of pharmacologic therapies. Although current guidelines favor novel P2Y12 inhibitors (prasugrel and ticagrelor) over clopidogrel, particularly in acute coronary syndrome (ACS), it is unclear whether these recommendations have reduced gender-based differences in prescribing patterns.

We analyzed 10,415 patients who underwent percutaneous coronary intervention across 14 hospitals in five US states between October 2018 and October 2023. Baseline characteristics were compared using chi-square and t-tests. Logistic regression was performed to adjust for confounding factors. Temporal trends were assessed, and subgroup analyses were conducted among ACS patients.

Women were significantly less likely than men to be prescribed novel P2Y12 inhibitors over clopidogrel (OR 0.74, 95% CI: 0.69-0.80; p < 0.001), and this disparity persisted after adjustment (adjusted OR 0.83, 95% CI: 0.76-0.9; p < 0.001). In the ACS subgroup, women had lower odds of receiving novel therapies in unadjusted analyses (OR 0.77, 95% CI: 0.67-0.89; p < 0.001), though this difference was no longer statistically significant after adjustment (adjusted OR 0.92, 95% CI: 0.79-1.07; p = 0.28). Notably, after 2021, no sex-based difference in the prescription of newer therapies was observed within the ACS population.

In patients with ACS, gender differences in P2Y12 inhibitor use disappeared after 2021, likely reflecting better adherence to current guidelines. However, among those undergoing PCI for non-ACS indications, significant sex disparities in DAPT selection remain.