Influence of sex on the timing of coronary angiography and the prescription of antiplatelet therapy in patients with nonST-segment elevation myocardial infarction

Antonio Martínez-Guisado 1, Pedro Cepas-Guillén1, Pablo Díez-Villanueva2, María Thiscal López Lluva3, Alfonso Jurado-Román4, Pablo Bazal-Chacón5, Martín Negreira-Caamaño6, Iván Olavarri-Miguel7, Ane Elorriaga8, Ricardo Rivera-López9, David Escribano10, Pablo Salinas11, Jessica Vaquero-Luna12, Alicia Prieto13, Lucía Pérez-Cebey14, Anna Carrasquer15, Isaac Llaó16, Fernando José Torres Mezcúa17, Teresa Giralt-Borrell18, Lucía Matute-Blanco19, Clara Fernández-Cordón20, Clea González3, Emilio Arbas-Redondo4, David Aritza-Conty5, Felipe Díez-Delhoyo21

Affiliation of the authors

1Servicio de Cardiología, Hospital Clinic, Barcelona, Spain. 2Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, Spain. 3Servicio de Cardiología, Hospital Universitario de León, León, Spain. 4Servicio de Cardiología, Hospital La Paz, Madrid, Spain. 5Servicio de Cardiología, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain. 6Servicio de Cardiología, Hospital General Universitario Ciudad Real, Ciudad Real, Spain. 7Servicio de Cardiología, Hospital Marqués de Valdecilla, Santander, Cantabria, Spain. 8Servicio de Cardiología, Hospital Universitario de Basurto, Bilbao, Vizcaya, Spain. 9Servicio de Cardiología, Hospital Virgen de las Nieves, Granada, Spain. 10Servicio de Cardiología, Hospital Universitario San Juan de Alicante, San Juan de Alicante, Spain. 11Servicio de Cardiología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain. 12Servicio de Cardiología, Hospital Txagorritxu, Vitoria, Spain. 13Servicio de Cardiología, Hospital Universitario de Albacete, Albacete, Spain. 14Servicio de Cardiología, Hospital Universitario de A Coruña, A Coruña, Spain. 15Servicio de Cardiología, Hospital Joan XXIII, Tarragona, Spain. 16Servicio de Cardiología, Hospital de Bellvitge, L´Hospitalet de Llobregat, Barcelona, Spain. 17Servicio de Cardiología, Hospital Universitario de Alicante Doctor Balmis, Alicante, Spain. 18Servicio de Cardiología, Hospital del Mar, Barcelona, Spain. 19Servicio de Cardiología, Hospital Universitario Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain. 20Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain. 21Servicio de Cardiología, Hospital Universitario 12 Octubre, Madrid, Spain.



Martínez-Guisado A, Cepas-Guillén P, Díez-Villanueva P, López Lluva MT, Jurado-Román A, Bazal-Chacón P, et al. Influence of sex on the timing of coronary angiography and the prescription of antiplatelet therapy in patients with nonST-segment elevation myocardial infarction. Emergencias. 2024;36:123-30



To assess differences in the clinical management of nonST-segment elevation myocardial infarction (NSTEMI), including in-hospital events, according to biological sex.


Prospective observational multicenter study of patients diagnosed with NSTEMI and atherosclerosis who underwent coronary angiography.


We enrolled 1020 patients in April and May 2022; 240 (23.5%) were women. Women were older than men on average (72.6 vs 66.5 years, P < .001), and more women were frail (17.1% vs 5.6%, P < .001). No difference was observed in pretreatment with any P2Y12 inhibitor (prescribed in 68.8% of women vs 70.2% of men, P = .67); however, more women than men were prescribed clopidogrel (56% vs 44%, P = .009). Women prescribed clopidogrel were more often under the age of 75 years and not frail. Coronary angiography was performed within 24 hours less corooften in women (29.8% vs 36.9%, P = .03) even when high risk was recognized. Frailty was independently associated with deferring coronary angiography in the adjusted analysis; biological sex by itself was not related. The frequency and type of revascularization were the same in both sexes, and there were no differences in in-hospital cardiovascular


Women were more often prescribed less potent antithrombotic therapy than men. Frailty, but not sex, correlated independently with deferral of coronary angiography. However, we detected no differences in the frequency of coronary revascularization or in-hospital events according to sex.


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