Evaluation of Sex-Based Differences in the Prescription of the Combination of Evidence-Based Medicine After the Occurrence of an Acute ST-Elevation Myocardial Infarction.

AIM: To evaluate sex-based differences in the prescription of the combination of evidence-based medicine (cEBM) at discharge after an acute ST-elevation myocardial infarction (STEMI). Secondly, we analysed risk factors for the absence of cEBM after discharge, and examined sex differences in adverse events.

METHODS

This retrospective cohort study compared women to men who were admitted with an acute STEMI at Haga Teaching Hospital between January 2017 and June 2023. The primary outcome was cEBM, defined as an active prescription of the combination of acetylsalicylic acid, P2Y12-inhibitor, ACEi/ARB, beta-blocker, and statin/ezetimibe on the day after discharge.

RESULTS

Among 1467 patients (27% women), women were older than men (74 years vs. 65 years, p < 0.001). cEBM was less often prescribed to women than men (66.0% vs. 72.8%, p = 0.013), primarily due to ACEi/ARB (82.1% vs. 87.7%, p = 0.007) and statins (90.2% vs. 95.2%, p = 0.001). In a multivariable logistic regression analysis, female sex was not associated with the absence of cEBM (Odds Ratio (OR) = 1.01, 95% confidence interval [95% CI]: 0.73-1.39). Other confounders such as increasing age, decreasing haemoglobin, and oral anticoagulants were correlated with the absence of cEBM.

CONCLUSIONS

A smaller proportion of women were prescribed cEBM post-STEMI compared to men. However, this difference disappeared when controlled for other confounders. Also, women remained to have a higher chance for a stroke or death at 6 months post-discharge. These findings highlight the need for further research into sex disparities and their underlying confounders in the field of evidence-based medicine after an acute STEMI.