Author + information
- Olga Salianski,
- Usman Baber,
- Samantha Sartori,
- Melissa Aquino,
- Jaya Chandrasekhar,
- Annapoorna Kini,
- Sunil Rao,
- William Weintraub,
- Sandra Weiss,
- Timothy Henry,
- Samir Kapadia,
- Kanhaiya Poddar,
- Anthony DeFranco,
- J. Muhlestein,
- Catalin Toma,
- Mark Effron,
- Stuart Keller,
- Brian Baker,
- Stuart Pocock and
- Roxana Mehran
The determinants of clinical decision-making for potent platelet inhibition with prasugrel versus clopidogrel in real-world patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) remain poorly characterized.
The purpose of this study was to identify factors which independently influence physicians’ choice between prasugrel versus clopidogrel at time of PCI in ACS patients.
We queried the PROMETHEUS database, a multicenter observational registry of 19,414 patients with ACS undergoing PCI at 8 U.S. medical centers. Baseline demographic, clinical and procedural parameters were compared between patients receiving prasugrel versus clopidogrel. Independent associations for each domain were identified using multivariable logistic regression.
Out of 19,414 PROMETHEUS patients, 4,058(20%) received prasugrel and 15,856 (80%) clopidogrel. The strongest demographic, clinical and procedural parameters for prasugrel use were younger age, prior cerebrovascular disease and non 2nd-generation stent implantation, respectively (Table). The final model yielded an overall c-statistic of 0.74.
Patients selected to receive prasugrel at time of PCI are characterized by a lower risk demographic and clinical profile, although prasugrel use was also more common in patients receiving longer stents.
|Risk Factor||Prasugrel (OR, 95% CI)||P-value||z-statistic|
|African-American Race||0.42 [0.37-0.49]||<0.0001||−11.92|
|Female Sex||0.78 [0.72-0.84]||<0.0001||−5.80|
|Body Mass Index (per 1 unit increase)||1.01 [1.005-1.017]||<0.0001||3.77|
|Prior Cerebrovascular Disease||0.51 [0.43-0.60]||<0.0001||−8.28|
|Prior Bypass Surgery||0.61 [0.54-0.69]||<0.0001||−7.68|
|Prior Myocardial Infarction||0.72 [0.66-0.82]||<0.0001||−6.69|
|Chronic Kidney Disease||0.74 [0.66-0.82]||<0.0001||−5.77|
|Bare-Metal Stent (vs. 2nd generation)||0.43 [0.39-0.48]||<0.0001||−15.20|
|1st Generation DES (vs. 2nd generation)||0.36 [0.32-0.42]||<0.0001||−14.61|
|Stent Length > 40 mm||1.30 [1.18-1.44]||<0.0001||5.24|
|Stent Diameter > 3.0 mm||1.27 [1.15-1.41]||<0.0001||4.71|
|Procedural Bivalirudin||0.83 [0.75-0.91]||<0.0001||−3.93|
|Stent Length 20 mm – 40 mm||1.16 [1.06-1.26]||0.001||3.39|
|Stent Diameter 2.5 mm – 3.0 mm||1.14 [1.05-1.26]||0.003||2.99|
Poster Area, South Hall A1
Saturday, April 02, 2016, 3:45 p.m.-4:30 p.m.
Session Title: ACC.i2 Interventional Cardiology: Complex Patients/Comorbidities
Abstract Category: 5. ACC.i2 Interventional Cardiology: Complex Patients/Comorbidities
Presentation Number: 1144-181
- 2016 American College of Cardiology Foundation