PII-050 - IMPACT OF SOCIAL DETERMINANTS OF HEALTH COMPOSITE MEASURES ON OUTCOMES AFTER PCI IN P2Y12 INHIBITOR-TREATED PATIENTS

J. Malave¹, C. Thomas¹, F. Franchi², E. Keeley¹, C. McDonough³, L. Ortega⁴, D. Angiolillo², C. Lee⁵, L. Cavallari⁶; ¹University of Florida, Gainesville, FL, USA, ²University of Florida, Jacksonville, FL, USA, ³Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, Florida., Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida - Gainesville, Florida., USA, ⁴University of Florida, Jacksonville, Florida, United States, ⁵University of North Carolina at Chapel Hill, Chapel Hill, NC, United States, ⁶University of Florida, Gainesville, FL, United States.

Background: Social deprivation is associated with increased morbidity and mortality. However, there is a paucity of data on the effect of social deprivation on outcomes following percutaneous coronary intervention (PCI), stratified by P2Y12 inhibitor therapy. The objective of this study was to evaluate the association between social deprivation and the incidence of major adverse cardiovascular events (MACE) in patients discharged on clopidogrel or alternative (prasugrel or ticagrelor) therapy following PCI.

Methods: Patients who underwent CYP2C19 genotyping to guide post-PCI antiplatelet therapy at the University of Florida were included. Social deprivation index (SDI) and social vulnerability metric (SVM) scaled from zero (least deprived) to 100 (most deprived) at the zip code tabulation area-level were used to define social deprivation. The primary outcome was MACE (composite of cardiovascular death, myocardial infarction, stroke, or stent thrombosis). Multivariate COX regression was used to evaluate the association between continuous SDOH scores and risk of MACE. Mann-Whitney U test was performed to compare SDI scores and SVM percentiles between treatment groups. All models were adjusted for age, race, sex, and CYP2C19 genotype.

Results: Of 1801 patients (mean age 63±12, 34% female, 20% Black), 1183 received clopidogrel and 618 received alternative therapy. Median (IQR) SDI score and SVM percentile for the full cohort were 61 (42-79) and 62 (43-89), respectively. Median SVM percentile was similar between clopidogrel-treated and alternative therapy patients [62 (43-89) and 59 (43-90); p=0.4], but clopidogrel-treated patients tended to have higher SDI scores [61 (43-81) and 60 (42-79); p=0.03]. Among clopidogrel-treated patients, both SDI (adj HR: 1.01; 95%CI: 1.00-1.02; p=0.04) and SVM (adj HR: 1.01; 95%CI: 1.00-1.02; p=0.01) were positively associated with MACE, with risk increasing linearly (e.g., each one-point increase in score resulted in a 1% increase in risk). This association was not observed in patients receiving alternative therapy.

Conclusion: These data suggest social deprivation is associated with an increased MACE risk in clopidogrel-treated patients following PCI, but may not be associated in those treated with prasugrel or ticagrelor.