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

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology Pub Date : 2025-09-15 DOI:10.1002/clc.70195

A. Evelo, E. Leegwater, W. J. R. Rietdijk, T. D. Warning, C. E. Schotborgh, L. E. Visser

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Abstract

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.

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急性st段抬高型心肌梗死发生后循证医学联合处方的性别差异评价

目的评价急性st段抬高型心肌梗死（STEMI）出院时循证医学联合用药（cEBM）处方的性别差异。其次，我们分析了出院后缺乏cEBM的危险因素，并检查了不良事件的性别差异。方法：本回顾性队列研究比较了2017年1月至2023年6月期间在Haga教学医院因急性STEMI入院的女性和男性。主要终点是cEBM，定义为出院后第一天乙酰水杨酸、p2y12抑制剂、ACEi/ARB、受体阻滞剂和他汀类药物/依折替米贝联合使用的有效处方。结果1467例患者（27%为女性）中，女性年龄大于男性（74岁比65岁，p < 0.001）。女性使用cEBM的频率低于男性（66.0% vs. 72.8%, p = 0.013），主要是由于ACEi/ARB （82.1% vs. 87.7%, p = 0.007）和他汀类药物（90.2% vs. 95.2%, p = 0.001）。在多变量logistic回归分析中，女性与缺乏cEBM无关（优势比(OR) = 1.01, 95%可信区间[95% CI]: 0.73-1.39）。其他混杂因素如年龄增长、血红蛋白下降和口服抗凝剂与cEBM的缺失相关。结论：与男性相比，女性在stemi后服用cEBM的比例较小。然而，当控制其他混杂因素时，这种差异就消失了。此外，女性在出院后6个月中风或死亡的几率仍然较高。这些发现强调了在急性STEMI后的循证医学领域对性别差异及其潜在混杂因素进行进一步研究的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Cardiology 医学-心血管系统

CiteScore

5.10

自引率

3.70%

发文量

189

审稿时长

4-8 weeks

期刊介绍： Clinical Cardiology provides a fully Gold Open Access forum for the publication of original clinical research, as well as brief reviews of diagnostic and therapeutic issues in cardiovascular medicine and cardiovascular surgery. The journal includes Clinical Investigations, Reviews, free standing editorials and commentaries, and bonus online-only content. The journal also publishes supplements, Expert Panel Discussions, sponsored clinical Reviews, Trial Designs, and Quality and Outcomes.