Gender Disparity in Secondary Prevention Medication and Outcomes Following Percutaneous Coronary Intervention for Acute Coronary Syndrome

Abstract

Background: Women continue to receive suboptimal secondary prevention medications following acute coronary syndrome (ACS), however, impact on long-term outcomes are not well documented. Methods: We analysed data on medical management 30-days post percutaneous coronary intervention for ACS in 20,976 consecutive patients in the Melbourne Interventional Group registry (2005-2018). Optimal medical therapy (OMT) was defined as 5 guideline-recommended medications, near-optimal (NMT) as 4 medications, and sub-optimal (SMT) as ≤3 medications. Long-term mortality was determined by National-Death Index linkage. Results: 65% of patients were prescribed OMT, 27% NMT and 8% SMT. Mean age 64 ± 12 years; 24% (4,931) female. Women were older (68 ± 12 vs. 62 ± 12 years) and had more comorbidities (higher BMI, hypertension, dyslipidaemia, diabetes and renal failure) than males, all p ≤ 0.001. Women were less likely to receive OMT (61% vs. 66%) and more likely to receive SMT (10% vs. 8%) compared to men, p < 0.001. At 12-months (n = 17,224) women were more likely to have recurrent MI (6% vs. 5%, p = 0.001), major bleeding (2.3% vs. 0.9%, p = 0.001), stroke (1.5% vs. 0.8%, p < 0.001) and MACE (13% vs. 11%, p = 0.026). At mean 5.3 year follow up, women had higher mortality (20% vs. 13%, p < 0.001). Conclusion: Women are less likely to be prescribed optimal secondary prevention medications following ACS and have poorer 12-month outcomes and long-term survival.