Sex differences in high-potency P2Y12 inhibitors prescription among patients with acute myocardial infarction.

BACKGROUND

Sex differences in the outcomes of patients with acute myocardial infarction (AMI) persist and could be related to the differences in management including high-potency P2Y12 inhibitors.

METHODS

Patients with AMI undergoing percutaneous coronary intervention (PCI) from the American Heart Association Get With The Guidelines®-Coronary Artery Disease Registry between October 2019 to December 2022 were included. Multivariable hierarchical models were used to assess whether there are differences in high-potency P2Y12 inhibitors (i.e., ticagrelor or prasugrel) prescription at discharge adjusting for race/ethnicity, insurance, age, social vulnerability index (SVI), zip code designation, and medical history.

RESULTS

Among 131,153 patients with AMI who underwent PCI, 59.8 % were discharged on a high-potency P2Y12 inhibitor. Compared with men, women were less likely prescribed a high-potency P2Y12 inhibitor (57.6 % vs 63.1 %), and this pattern did not change during the study period. Among women, the likelihood of high-potency P2Y12 inhibitors prescription was not significantly different across different race/ethnicities. However, in men, non-Hispanic Blacks and Hispanics had lower odds of high-potency P2Y12 inhibitors prescription compared with non-Hispanic Whites among men. The SVI was not independently associated with high-potency P2Y12 inhibitors in women or men.

CONCLUSIONS

In this large contemporary observational analysis of patients with AMI undergoing PCI, women irrespective of race/ethnicity were less likely prescribed a high-potency P2Y12 inhibitor upon discharge. These associations were not influenced by social determinants of health as reflected by the SVI. These findings highlight an opportunity for continued education and dissemination to optimize antiplatelet therapy selection to improve outcomes among AMI patients undergoing PCI.