OAI-003 - REAL-WORLD CLINICAL OUTCOMES BY P2Y12 INHIBITOR THERAPY AND GENOTYPE IN BLACK VERSUS NON-BLACK PATIENTS FOLLOWING PCI.

C. Thomas¹, J. Malave¹, J. Rossi², F. Franchi³, E. Keeley¹, C. McDonough¹, L. Ortega-Paz³, A. Beitelshees⁴, J. Duarte¹, G. Stouffer², D. Angiolillo³, C. Lee², L. Cavallari¹; ¹University of Florida, Gainesville, FL, USA, ²University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, ³University of Florida, Jacksonville, FL, USA, ⁴University of Maryland, Baltimore, MD, USA.

Background: Worse outcomes have been reported in Black versus non-Black patients after percutaneous coronary intervention (PCI). However, it remains unknown whether P2Y12 inhibitor therapy or CYP2C19 genotype contribute to disparities in outcomes. Therefore, we compared post-PCI outcomes between self-reported Black and non-Black patients after stratifying by CYP2C19 status and P2Y12 inhibitor therapy.

Methods: Patients who underwent PCI and clinical CYP2C19 genotyping to guide P2Y12 inhibitor therapy across five institutions were included. Major adverse cardiovascular events (MACE; composite of cardiovascular death, myocardial infarction, ischemic stroke, or stent thrombosis) within 1-year post-PCI were ascertained for patients. Patients treated with prasugrel and ticagrelor were combined for analysis. Multivariable Cox regression was used to evaluate MACE risk in self-reported Black versus non-Black patients after stratifying by P2Y12 inhibitor and CYP2C19 no-function allele status (in clopidogrel-treated patients) and further adjusting for characteristic differing between groups.

Results: A total of 4,335 patients (median age 63 years, 21% Black, 33% female, 72% with an acute coronary syndrome, 31% with CYP2C19 no-function allele) were included. Among CYP2C19 no-function allele carriers treated with clopidogrel, MACE rates were higher among Black versus non-Black patients (Table). Event rates were not different between clopidogrel-treated Black versus non-Black patients without a no-function allele or among prasugrel/ticagrelor-treated patients.

Conclusion: At 1-year post-PCI, MACE rates were higher among Black versus non-Black patients with a CYP2C19 no-function allele treated with clopidogrel, but no difference was observed by self-reported race among those without a no-function allele treated with clopidogrel or prasugrel/ticagrelor treated patients. Identifying factors contributing to the higher risk in Black patients is important to inform interventions to reduce disparities in outcomes after PCI.