Use of prasugrel and clinical outcomes in African-American patients treated with percutaneous coronary intervention for acute coronary syndromes

Catheter Cardiovasc Interv. 2019 Jul 1;94(1):53-60. doi: 10.1002/ccd.28033. Epub 2019 Jan 17.

Abstract

Objective: To investigate the use of prasugrel after percutaneous coronary intervention (PCI) in African American (AA) patients presenting with acute coronary syndrome (ACS).

Background: AA patients are at higher risk for adverse cardiovascular outcomes after PCI and may derive greater benefit from the use of potent antiplatelet therapy.

Methods: Using the multicenter PROMETHEUS observational registry of ACS patients treated with PCI, we grouped patients by self-reported AA or other races. Clinical outcomes at 90-day and 1-year included non-fatal myocardial infarction (MI), major adverse cardiac events (composite of death, MI, stroke, or unplanned revascularization) and major bleeding.

Results: The study population included 2,125 (11%) AA and 17,707 (89%) non-AA patients. AA patients were younger, more often female (46% vs. 30%) with a higher prevalence of diabetes mellitus, chronic kidney disease, and prior coronary intervention than non-AA patients. Although AA patients more often presented with troponin (+) ACS, prasugrel use was much less common in AA vs. non-AA (11.9% vs. 21.4%, respectively, P = 0.001). In addition, the use of prasugrel increased with the severity of presentation in non-AA but not in AA patients. Multivariable logistic regression showed AA race was an independent predictor of reduced use of prasugrel (0.42 [0.37-0.49], P < 0.0001). AA race was independently associated with a significantly higher risk of MI at 90-days and 1 year after PCI.

Conclusions: Despite higher risk clinical presentation and worse 1-year ischemic outcomes, AA race was an independent predictor of lower prasugrel prescription in a contemporary population of ACS patients undergoing PCI.

Keywords: African-American; acute coronary syndrome; clinical outcomes; percutaneous coronary intervention; prasugrel; race.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Acute Coronary Syndrome / diagnosis
  • Acute Coronary Syndrome / ethnology
  • Acute Coronary Syndrome / mortality
  • Acute Coronary Syndrome / therapy*
  • African Americans*
  • Age Factors
  • Aged
  • Cause of Death
  • Clopidogrel / adverse effects
  • Clopidogrel / therapeutic use*
  • Comorbidity
  • Female
  • Health Status Disparities*
  • Healthcare Disparities / ethnology*
  • Hemorrhage / chemically induced
  • Hemorrhage / ethnology
  • Hemorrhage / mortality
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention* / adverse effects
  • Percutaneous Coronary Intervention* / mortality
  • Platelet Aggregation Inhibitors / adverse effects
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Prasugrel Hydrochloride / adverse effects
  • Prasugrel Hydrochloride / therapeutic use*
  • Prevalence
  • Prospective Studies
  • Race Factors
  • Registries
  • Risk Assessment
  • Risk Factors
  • Sex Factors
  • Stroke / ethnology
  • Stroke / mortality
  • Time Factors
  • Treatment Outcome
  • United States / epidemiology

Substances

  • Platelet Aggregation Inhibitors
  • Clopidogrel
  • Prasugrel Hydrochloride