Sex disparity in secondary prevention pharmacotherapy and clinical outcomes following acute coronary syndrome
Aims: We sought to investigate if sex disparity exists for secondary prevention pharmacotherapy following acute coronary syndrome (ACS) and impact on long-term clinical outcomes. Methods and results: We analysed data on medical management 30-day post-percutaneous coronary intervention (PCI) for ACS...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Journal Article |
| Language: | English |
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OXFORD UNIV PRESS
2022
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| Subjects: | |
| Online Access: | http://purl.org/au-research/grants/nhmrc/1111170 http://hdl.handle.net/20.500.11937/93092 |
| _version_ | 1848765695163105280 |
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| author | Dagan, M. Dinh, D.T. Stehli, J. Tan, C. Brennan, A. Warren, J. Ajani, A.E. Freeman, M. Murphy, A. Reid, Christopher Hiew, C. Oqueli, E. Clark, D.J. Duffy, S.J. |
| author_facet | Dagan, M. Dinh, D.T. Stehli, J. Tan, C. Brennan, A. Warren, J. Ajani, A.E. Freeman, M. Murphy, A. Reid, Christopher Hiew, C. Oqueli, E. Clark, D.J. Duffy, S.J. |
| author_sort | Dagan, M. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | Aims: We sought to investigate if sex disparity exists for secondary prevention pharmacotherapy following acute coronary syndrome (ACS) and impact on long-term clinical outcomes. Methods and results: We analysed data on medical management 30-day post-percutaneous coronary intervention (PCI) for ACS in 20 976 patients within the multicentre Melbourne Interventional Group registry (2005-2017). Optimal medical therapy (OMT) was defined as five guideline-recommended medications, near-optimal medical therapy (NMT) as four medications, sub-optimal medical therapy (SMT) as ≤3 medications. Overall, 65% of patients received OMT, 27% NMT and 8% SMT. Mean age was 64 ± 12 years; 24% (4931) were female. Women were older (68 ± 12 vs. 62 ± 12 years) and had more comorbidities. 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. On long-term follow-up (median 5 years, interquartile range 2-8 years), women had higher unadjusted mortality (20% vs. 13%, P < 0.001). However, after adjusting for medical therapy and baseline risk, women had lower long-term mortality [hazard ratio (HR) 0.88, 95% confidence interval (CI) 0.79-0.98; P = 0.02]. NMT (HR 1.17, 95% CI 1.05-1.31; P = 0.004) and SMT (HR 1.79, 95% CI 1.55-2.07; P < 0.001) were found to be independent predictors of long-term mortality. Conclusion: Women are less likely to be prescribed optimal secondary prevention medications following PCI for ACS. Lower adjusted long-term mortality amongst women suggests that as well as baseline differences between gender, optimization of secondary prevention medical therapy amongst women can lead to improved outcomes. This highlights the need to focus on minimizing the gap in secondary prevention pharmacotherapy between sexes following ACS. |
| first_indexed | 2025-11-14T11:39:20Z |
| format | Journal Article |
| id | curtin-20.500.11937-93092 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-14T11:39:20Z |
| publishDate | 2022 |
| publisher | OXFORD UNIV PRESS |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-930922023-09-06T01:56:54Z Sex disparity in secondary prevention pharmacotherapy and clinical outcomes following acute coronary syndrome Dagan, M. Dinh, D.T. Stehli, J. Tan, C. Brennan, A. Warren, J. Ajani, A.E. Freeman, M. Murphy, A. Reid, Christopher Hiew, C. Oqueli, E. Clark, D.J. Duffy, S.J. Science & Technology Life Sciences & Biomedicine Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology Women Optimal medical therapy Guideline-directed medical therapy Acute coronary syndrome Secondary prevention ACUTE MYOCARDIAL-INFARCTION AMERICAN-HEART-ASSOCIATION DISEASE WOMEN CARE MANAGEMENT INITIATION STATEMENT FAILURE COLLEGE Acute coronary syndrome Guideline-directed medical therapy Optimal medical therapy Secondary prevention Women Acute Coronary Syndrome Aged Female Humans Male Middle Aged Percutaneous Coronary Intervention Registries Secondary Prevention Treatment Outcome Humans Treatment Outcome Registries Aged Middle Aged Female Male Acute Coronary Syndrome Secondary Prevention Percutaneous Coronary Intervention Aims: We sought to investigate if sex disparity exists for secondary prevention pharmacotherapy following acute coronary syndrome (ACS) and impact on long-term clinical outcomes. Methods and results: We analysed data on medical management 30-day post-percutaneous coronary intervention (PCI) for ACS in 20 976 patients within the multicentre Melbourne Interventional Group registry (2005-2017). Optimal medical therapy (OMT) was defined as five guideline-recommended medications, near-optimal medical therapy (NMT) as four medications, sub-optimal medical therapy (SMT) as ≤3 medications. Overall, 65% of patients received OMT, 27% NMT and 8% SMT. Mean age was 64 ± 12 years; 24% (4931) were female. Women were older (68 ± 12 vs. 62 ± 12 years) and had more comorbidities. 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. On long-term follow-up (median 5 years, interquartile range 2-8 years), women had higher unadjusted mortality (20% vs. 13%, P < 0.001). However, after adjusting for medical therapy and baseline risk, women had lower long-term mortality [hazard ratio (HR) 0.88, 95% confidence interval (CI) 0.79-0.98; P = 0.02]. NMT (HR 1.17, 95% CI 1.05-1.31; P = 0.004) and SMT (HR 1.79, 95% CI 1.55-2.07; P < 0.001) were found to be independent predictors of long-term mortality. Conclusion: Women are less likely to be prescribed optimal secondary prevention medications following PCI for ACS. Lower adjusted long-term mortality amongst women suggests that as well as baseline differences between gender, optimization of secondary prevention medical therapy amongst women can lead to improved outcomes. This highlights the need to focus on minimizing the gap in secondary prevention pharmacotherapy between sexes following ACS. 2022 Journal Article http://hdl.handle.net/20.500.11937/93092 10.1093/ehjqcco/qcab007 English http://purl.org/au-research/grants/nhmrc/1111170 OXFORD UNIV PRESS unknown |
| spellingShingle | Science & Technology Life Sciences & Biomedicine Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology Women Optimal medical therapy Guideline-directed medical therapy Acute coronary syndrome Secondary prevention ACUTE MYOCARDIAL-INFARCTION AMERICAN-HEART-ASSOCIATION DISEASE WOMEN CARE MANAGEMENT INITIATION STATEMENT FAILURE COLLEGE Acute coronary syndrome Guideline-directed medical therapy Optimal medical therapy Secondary prevention Women Acute Coronary Syndrome Aged Female Humans Male Middle Aged Percutaneous Coronary Intervention Registries Secondary Prevention Treatment Outcome Humans Treatment Outcome Registries Aged Middle Aged Female Male Acute Coronary Syndrome Secondary Prevention Percutaneous Coronary Intervention Dagan, M. Dinh, D.T. Stehli, J. Tan, C. Brennan, A. Warren, J. Ajani, A.E. Freeman, M. Murphy, A. Reid, Christopher Hiew, C. Oqueli, E. Clark, D.J. Duffy, S.J. Sex disparity in secondary prevention pharmacotherapy and clinical outcomes following acute coronary syndrome |
| title | Sex disparity in secondary prevention pharmacotherapy and clinical outcomes following acute coronary syndrome |
| title_full | Sex disparity in secondary prevention pharmacotherapy and clinical outcomes following acute coronary syndrome |
| title_fullStr | Sex disparity in secondary prevention pharmacotherapy and clinical outcomes following acute coronary syndrome |
| title_full_unstemmed | Sex disparity in secondary prevention pharmacotherapy and clinical outcomes following acute coronary syndrome |
| title_short | Sex disparity in secondary prevention pharmacotherapy and clinical outcomes following acute coronary syndrome |
| title_sort | sex disparity in secondary prevention pharmacotherapy and clinical outcomes following acute coronary syndrome |
| topic | Science & Technology Life Sciences & Biomedicine Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology Women Optimal medical therapy Guideline-directed medical therapy Acute coronary syndrome Secondary prevention ACUTE MYOCARDIAL-INFARCTION AMERICAN-HEART-ASSOCIATION DISEASE WOMEN CARE MANAGEMENT INITIATION STATEMENT FAILURE COLLEGE Acute coronary syndrome Guideline-directed medical therapy Optimal medical therapy Secondary prevention Women Acute Coronary Syndrome Aged Female Humans Male Middle Aged Percutaneous Coronary Intervention Registries Secondary Prevention Treatment Outcome Humans Treatment Outcome Registries Aged Middle Aged Female Male Acute Coronary Syndrome Secondary Prevention Percutaneous Coronary Intervention |
| url | http://purl.org/au-research/grants/nhmrc/1111170 http://hdl.handle.net/20.500.11937/93092 |