Abstract 116: Is There Gender Disparity in the Use of Drug Eluting Stents after Acute Myocardial Infarction?

Abstract

Background: Women are less likely than men to have cardiac catheterization and percutaneous coronary intervention (PCI) after acute myocardial infarction (AMI). It is unclear whether such gender disparity extends to the implantation of the type of coronary stent (bare metal stent (BMS) versus drug eluting stent (DES)) after AMI. Methods: We examined coronary stent implantation by type within 30 days of AMI in 33,748 patients admitted to non-federal hospitals in New Jersey using a statewide database. Data from 2003 through 2009 in the Myocardial Infarction Data Acquisition System (MIDAS) were used to identify patients with first episode of AMI and single type (BMS versus DES) of coronary stent implantation after the AMI. Multivariate logistic regression was used to analyze the differences by gender after adjustment for age, race, insurance, site of MI, pre-or post discharge stent implantation, and co-morbidities. Results: Coronary stent implantations after AMI were stratified by placement periods into: at index of AMI admission, n=16,719; within 2 days, n=22,019; within one week, n=31,618; and within 30 days of index AMI, n=33,748. In 2003, the use of BMS in women declined from 76% (386 of 507) to 68% (986 of 1454) from index AMI to 30 days, and in men from 79% (930 of 1181) to 70% (2017 of 2863). The use of DES in women increased from 24% (121 of 507) at index AMI to 32% (468 of 1454) at 30 days, and in men from 21% (251 of 1181) to 30% (846 of 2863). After adjustment for covariates, in 2003, women were more likely to receive DES than men within 2 days of the index AMI [Odds Ratio (OR): 1.37; 95% Confidence Interval (CI): (1.10, 1.70); p = 0.005], within 1 week of index AMI [OR: 1.21; CI (1.03,1.41); p= 0.02], within 30 days of index AMI [OR: 1.20; CI (1.03, 1.39); p = 0.02)]. In 2004 through 2009, both men and women had higher proportion of DES than BMS implantation after AMI. However, there was no significant gender difference in stent type for these years, except in 2006 when DES implants (received within 1 week and 30 days of index AMI) were significantly more frequent in women compared to men. Conclusion: Although women are less likely to receive PCI compared to men after AMI, there is generally no gender difference in the proportion of DES versus BMS received in contemporary years.