Sex-Specific Differences in Potent P2Y <sub>12</sub> Inhibitor Use in British Cardiovascular Intervention Society Registry STEMI Patients
Bibliographic record
Abstract
BACKGROUND: Sex-based outcome differences for women with ST-segment–elevation myocardial infarction (STEMI) have not been adequately addressed, and the role played by differences in prescription of potent P2Y 12 inhibitors (P-P2Y 12 ) is not well defined. This study explores the hypothesis that disparities in P-P2Y 12 (prasugrel or ticagrelor) use may play a role in outcome disparities for women with STEMI. METHODS: Data from British Cardiovascular Intervention Society national percutaneous coronary intervention database were analyzed, and 168 818 STEMI patients treated with primary percutaneous coronary intervention from 2010 to 2020 were included. RESULTS: Among the included women (43 131; 25.54%) and men (125 687; 74.45%), P-P2Y 12 inhibitors were prescribed less often to women (51.71%) than men (55.18%; P <0.001). Women were more likely to die in hospital than men (adjusted odds ratio, 1.213 [95% CI, 1.141–1.290]). Unadjusted mortality was higher among women treated with clopidogrel (7.57%), than P-P2Y 12 -treated women (5.39%), men treated with clopidogrel (4.60%), and P-P2Y 12 -treated men (3.61%; P <0.001). The strongest independent predictor of P-P2Y 12 prescription was radial access (adjusted odds ratio, 2.368 [95% CI, 2.312–2.425]), used in 67.93% of women and 74.38% of men ( P <0.001). Two risk adjustment models were used. Women were less likely to receive a P-P2Y 12 (adjusted odds ratio, 0.957 [95% CI, 0.935–0.979]) with risk adjustment for baseline characteristics alone, when procedural factors including radial access were included in the model differences were not significant (adjusted odds ratio, 1.015 [95% CI, 0.991–1.039]). CONCLUSIONS: Women were less likely to be prescribed prasugrel or ticagrelor, were less likely to have radial access, and had a higher mortality when being treated for STEMI. Improving rates of P-P2Y 12 use and radial access may decrease outcome disparities for women with STEMI.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".