Abstract Body (Do not enter title and authors here): Background: Sex and racial differences in the outcomes of patients with acute coronary syndrome (ACS) persist and could be related to the differences in management including high-potency P2Y12 inhibitors.

Aim: This study aims to examine the contribution of social determinants of health on the association between sex and racial differences in the prescription of high-potency P2Y12 inhibitor upon discharge.

Methods: Patients with ACS undergoing percutaneous coronary intervention (PCI) from the American Heart Association Get With The Guidelines®–Coronary Artery Disease Registry between October 2019 to December 2022 were included. Multivariable hierarchical models were used to assess whether there are differences in high-potency P2Y12 inhibitors (i.e., ticagrelor or prasugrel) prescription at discharge adjusting for race/ethnicity, insurance, age, social vulnerability index (SVI), zip code designation, and medical history. Analyses were performed in women and men separately.

Results: Among 135,153 patients with ACS who underwent PCI, 59.8% were discharged on a high-potency P2Y12 inhibitor. Compared with men, women were less likely prescribed high-potency P2Y12 inhibitor (66.9% vs 72%), and this pattern did not change during the study period (P=0.50) (Figure). There was a significant interaction between sex and race for high-potency P2Y12 inhibitor prescription (P< 0.05). Among women, the likelihood of high-potency P2Y12 inhibitors prescription was not significantly different across different race/ethnicities. However, in men, non-Hispanic Blacks and Hispanics had lower odds of high-potency P2Y12 inhibitors prescription compared with non-Hispanic Whites among men after adjusting for all covariates.

Conclusions: In this large contemporary observational analysis of patients with AMI undergoing PCI, women were less likely prescribed a high-potency P2Y12 inhibitor upon discharge. Among women, the likelihood of high-potency P2Y12 inhibitors prescription was not significantly different across different race/ethnicities; however, in men, non-Hispanic Blacks and Hispanics had lower odds of high-potency P2Y12 inhibitors prescription. Further efforts should be directed to minimize these sex and racial disparities.