Women Face Lower Odds of Receiving High-Potency P2Y12 Inhibitors After Heart Attack: CRM, July 2025 Analysis Finds

These findings are published in July 2025 in Cardiovascular Revascularization Medicine.

The Persistent Disparity in Post-Ischemic Management

High-potency P2Y12 inhibitors, specifically ticagrelor and prasugrel, are medications known to reduce the risk of major adverse cardiac events (MACE) compared to older therapies like clopidogrel. Clinical guidelines preferentially recommend these potent agents for patients with AMI—commonly known as a heart attack—who undergo PCI. Despite these recommendations and the clear benefit observed in both sexes, historical data has suggested that significant sex differences in medical management persist. While the use of these agents has increased overall, concerns remain that women may not be receiving optimized therapy. This study aimed to evaluate contemporary prescription patterns through the lens of sex, race, and various social determinants of health (SDoH).

Study Overview

The large-scale observational analysis utilized data from the American Heart Association (AHA) Get With The Guidelines®–Coronary Artery Disease (GWTG-CAD) Registry. The study cohort comprised 131,153 adult patients admitted between 2019 and 2022 who were diagnosed with ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI) and treated with PCI. Researchers examined the use of high-potency P2Y12 inhibitors at the time of hospital discharge, adjusting for patient demographics, medical history, and insurance status. Additionally, the study incorporated the social vulnerability index (SVI), a comprehensive measure that captures community-level vulnerability based on socioeconomic status, housing, and transportation, to determine if environmental factors influenced these treatment disparities.

The key findings from the analysis include:

• Among the total cohort of patients undergoing PCI, the overall prescription rate for high-potency P2Y12 inhibitors was 59.8%.

• A significant sex gap was identified: 63.1% of men were prescribed these medications compared to only 57.6% of women.

• Notably, the lower likelihood of receiving these inhibitors did not differ significantly by race or ethnicity among women, whereas racial disparities were evident among men.

• The analysis found that the SVI was not an independent predictor of prescription choice, suggesting the disparity is not primarily driven by community-level socioeconomic factors.

Clinical Relevance and Targeted Education

For practicing clinicians, the analysis reveals that gender disparities in antiplatelet therapy remain a persistent challenge in cardiovascular care. Women were consistently less likely to receive high-potency medications, and this trend showed no signs of improvement over the three-year study period—even as rates for men increased. The lack of association with the SVI implies that the discrepancy might be influenced by clinical perceptions of bleeding risk or uncaptured procedural factors such as vascular access choice. Because adherence to guideline-recommended therapies has been shown to mitigate excess mortality in women following a heart attack, closing this gap is a clinical priority. Healthcare systems should focus on continued education and the dissemination of standardized protocols to ensure that every patient receiving PCI is evaluated for the most effective antiplatelet regimen, regardless of their sex or race.

Reference

Mansoor, H., Poudel, R., Hong, H., Li, S., Thomas, K., Sigal, S., Tamis-Holland, J., Goyal, A., & Elgendy, I. Y. (2026). Sex differences in high-potency P2Y12 inhibitors prescription among patients with acute myocardial infarction. Cardiovascular Revascularization Medicine, 83, 40–46