Impact of Area-Level Socioeconomic Deprivation on Post-PCI Outcomes Stratified by P2Y12 Inhibitor Therapy

Jean G Malavé; Cameron D Thomas; Francesco Franchi; Ellen C Keeley; Caitrin W McDonough; Luis Ortega-Paz; Danwei Shao; Joseph S Rossi; George A Stouffer; Masoud Rouhizadeh; Dominick J Angiolillo; Craig R Lee; Larisa H Cavallari

doi:10.1016/j.jacadv.2025.102577

Impact of Area-Level Socioeconomic Deprivation on Post-PCI Outcomes Stratified by P2Y₁₂ Inhibitor Therapy

JACC Adv. 2026 Mar;5(3):102577. doi: 10.1016/j.jacadv.2025.102577. Epub 2026 Feb 3.

Affiliations

¹ Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, Florida, USA.
² Division of Cardiology, Department of Medicine, College of Medicine-Jacksonville, University of Florida, Jacksonville, Florida, USA.
³ Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA.
⁴ Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
⁵ Division of Cardiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
⁶ Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA.
⁷ Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, Florida, USA. Electronic address: lcavallari@ufl.edu.

Abstract

Background: Social deprivation influences postpercutaneous coronary intervention (PCI) outcomes, but whether it affects outcomes by antiplatelet therapy is unknown.

Objectives: The impact of area-level social determinants of health on the effectiveness and safety of P2Y₁₂ inhibitors following PCI was assessed.

Methods: Data were abstracted from electronic health records for adults who underwent PCI and clinical cytochrome P450 2C19 genotyping and received a P2Y₁₂ inhibitor across 3 institutions. Social Deprivation Index (SDI) and Social Vulnerability Metric (SVM) were assigned using zip code tabulation areas. Multivariable Cox regression was used to evaluate the association between SDI and SVM (per unit increase) and risk for major atherothrombotic events (MAE) (death, myocardial infarction, stent thrombosis, ischemic stroke, or revascularization for unstable angina) and bleeding (Global Use of Strategies to Open Occluded Coronary Arteries Moderate-Severe) with clopidogrel and alternative therapy (eg, prasugrel or ticagrelor).

Results: Overall, 3,141 patients (mean age: 63 years; 33% female; 68% with acute coronary syndrome) were included. In clopidogrel-treated patients (n = 1,852), SDI was associated with higher risk for MAE (adjusted HR: 1.009; 95% CI: 1.001-1.016; P = 0.018) but not bleeding (adjusted HR: 1.001; 95% CI: 0.990-1.012; P = 0.838). In patients on alternative therapy (n = 1,289), SDI was associated with a higher risk for bleeding (adjusted HR: 1.014; 95% CI: 1.001-1.028; P = 0.048), but not MAE (adjusted HR: 0.998; 95% CI: 0.988-1.007; P = 0.652). SVM was not significantly associated with adverse outcomes with clopidogrel or alternative therapy after adjustment.

Conclusions: Higher SDI was associated with an increased risk of MAE with clopidogrel and bleeding with alternative therapy following PCI. Whether addressing socioeconomic disparities improves P2Y₁₂ inhibitor-related outcomes remains to be determined.

Keywords: CYP2C19; antiplatelet therapy; clopidogrel; percutaneous coronary intervention; social determinants of health.

Impact of Area-Level Socioeconomic Deprivation on Post-PCI Outcomes Stratified by P2Y₁₂ Inhibitor Therapy

Authors

Affiliations

Abstract

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