Stuart Keller

Sex‐related differences in outcomes among men and women under 55 years of age with acute coronary syndrome undergoing percutaneous coronary intervention: Results from the PROMETHEUS Study

Young women undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) experience greater adverse events than men, potentially due to under‐treatment. We sought to compare the 1‐year outcomes by sex in patients ≤55 years of age from a contemporary PCI cohort.

Use of prasugrel vs clopidogrel and outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention in contemporary clinical practice: Results from the PROMETHEUS study.

Background and objectives We sought to determine the frequency of use and association between prasugrel and outcomes in acute coronary syndrome patients undergoing percutaneous coronary intervention (PCI) in clinical practice. Methods PROMETHEUS was a multicenter observational registry of acute coronary syndrome patients undergoing PCI from 8 centers in the United States that maintained a prospective PCI registry for patient outcomes. The primary end points were major adverse cardiovascular events at 90 days, a composite of all‐cause death, nonfatal myocardial infarction, stroke, or unplanned revascularization. Major bleeding was defined as any bleeding requiring hospitalization or blood transfusion. Hazard ratios (HRs) were generated using multivariable Cox regression and stratified by the propensity to treat with prasugrel. Results Of 19,914 patients (mean age 64.4 years, 32% female), 4,058 received prasugrel (20%) and 15,856 received clopidogrel (80%). Prasugrel‐treated patients were younger with fewer comorbid risk factors compared with their counterparts receiving clopidogrel. At 90 days, there was a significant association between prasugrel use and lower major adverse cardiovascular event (5.7% vs 9.6%, HR 0.58, 95% CI 0.50‐0.67, P < .0001) and bleeding (1.9% vs 2.9%, HR 0.65, 95% CI 0.51‐0.83, P < .001). After propensity stratification, associations were attenuated and no longer significant for either outcome. Results remained consistent using different approaches to adjusting for potential confounders. Conclusions In contemporary clinical practice, patients receiving prasugrel tend to have a lower‐risk profile compared with those receiving clopidogrel. The lower ischemic and bleeding events associated with prasugrel use were no longer evident after accounting for these baseline differences.

Use of prasugrel vs clopidogrel and outcomes in patients with and without diabetes mellitus presenting with acute coronary syndrome undergoing percutaneous coronary intervention

BACKGROUND Clinical trial data studies suggest superiority of prasugrel over clopidogrel in patients with diabetes. However, the use, safety and efficacy profile of prasugrel in unselected diabetic patients presenting with acute coronary syndromes (ACS) remain unclear. METHODS PROMETHEUS was a prospective multicenter observational study of 19,919 ACS PCI patients enrolled between 2010 and 2013. The primary endpoint was 90-day major adverse cardiovascular events (MACE), comprising all-cause death, myocardial infarction, stroke or unplanned revascularization. The safety endpoint was bleeding requiring hospitalization. RESULTS We identified 7580 (38%) subjects with and 12,329 (62%) without diabetes. Diabetic patients were older and had significantly higher rates of cardiovascular risk factors. However, they were less likely to receive prasugrel (18.2% vs. 21.7%). Use of prasugrel did not increase with the severity of clinical presentation in diabetics, whereas, among non-diabetics, prescription of prasugrel was higher in NSTEMI and STEMI compared to unstable angina. The 90-day and 1-year adjusted risk of MACE was greater in diabetics (at 1 year: 22.7% vs. 16.5%; HR 1.22 [1.14-1.33], p < 0.001). At 1 year, the risk of bleeding was also higher in diabetics (4.9% vs. 4.1%, HR 1.19 [1.01-1.39], p = 0.035). After multivariable adjustment, use of prasugrel was associated with a lower risk of death in diabetic patients both at 90 days and 1 year. CONCLUSIONS Use of prasugrel in diabetic patients with PCI-treated ACS was lower than in non-diabetics despite their high-risk profile and the severity of their clinical presentation. In diabetics, prasugrel was associated with a lower adjusted risk of 90-day death compared with clopidogrel.

The prevalence, predictors and outcomes of guideline-directed medical therapy in patients with acute myocardial infarction undergoing PCI, an analysis from the PROMETHEUS registry

To investigate the prevalence, predictors and associations between guideline‐directed medical therapy (GDMT) and clinical outcomes in acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI) from eight academic centers in the United States.

TCT-271 Sex-related differences in outcomes after percutaneous coronary intervention (PCI) in patients with diabetes presenting with acute coronary syndrome (ACS): Results from the PROMETHEUS study

While overall mortality in cardiovascular disease has declined, some groups such as females with diabetes are still at increased risk for worse outcome after ACS. We aimed to compare 1-year outcomes between female and male ACS patients after PCI stratified by the presence of diabetes mellitus (DM

TCT-221 Predictors of optimal medical therapy on discharge after percutaneous coronary intervention for acute coronary syndrome: An analysis of the PROMETHEUS registry.

TCT-221 Predictors of optimal medical therapy on discharge after percutaneous coronary intervention for acute coronary syndrome: An analysis of the PROMETHEUS registry Serdar Farhan, Usman Baber, Jaya Chandrasekhar, Samantha Sartori, Melissa Aquino, Gennaro Giustino, Annapoorna Kini, William Weintraub, Sunil Rao, Samir Kapadia, Sandra Weiss, Craig Strauss, Catalin Toma, J. Brent Muhlestein, Anthony DeFranco, Mark Effron, Stuart Keller, Brian Baker, Stuart Pocock, Timothy Henry, Roxana Mehran Icahn School of Medicine at Mount Sinai; Mount Sinai Medical Center, New York, New York, United States; Mount Sinai Hospital, New York, New York, United States; The Icahn School of Medicine at Mount Sinai, New York, New York, United States; Mount Sinai Medical Center; The Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, United States; Unknown, New York, New York, United States; Christiana Care Health Services, Newark, Delaware, United States; Duke University Medical Center, Chapel Hill, North Carolina, United States; Cleveland Clinic, Cleveland, Ohio, United States; Christiana Care, Glen Mills, Pennsylvania, United States; National Heart Foundation Hospital and Research Institue; University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States; Intermountain Medical Center, Murray, Utah, United States; Aurora St Luke’s Medical Center, Milwaukee, Wisconsin, United States; Ochsner Medical Center, New Orleans, Louisiana, United States; Eli Lilly and Company, Indianapolis, Indiana, United States; Daiichi Sankyo, Inc., Parsippany, New Jersey, United States; London School of Hygiene and Tropical Medicine, London, United Kingdom; Cedars Sinai Heart Institute, Los Angeles, California, United States; Zena and Michael A. Weiner Cardiovascular Institute at Mount Sinai School of Medicine, New York, New York, United States

TCT-105 Prevalence of prasugrel use and associations between type of acute coronary syndrome and 1-year clinical outcomes.

TCT-105 Prevalence of prasugrel use and associations between type of acute coronary syndrome and 1-year clinical outcomes Asim Rafique, Jaya Chandrasekhar, Usman Baber, Samantha Sartori, Melissa Aquino, Samir Kapadia, Sunil Rao, J. Brent Muhlestein, Catalin Toma, Craig Strauss, William Weintraub, Sandra Weiss, Anthony DeFranco, Stuart Pocock, Mark Effron, Stuart Keller, Brian Baker, Annapoorna Kini, Roxana Mehran, Timothy Henry Cedars-Sinai Medical Center, Los Angeles, California, United States; Mount Sinai Hospital, New York, New York, United States; Mount Sinai Medical Center, New York, New York, United States; The Icahn School of Medicine at Mount Sinai, New York, New York, United States; Mount Sinai Medical Center; Cleveland Clinic, Cleveland, Ohio, United States; Duke University Medical Center, Chapel Hill, North Carolina, United States; Intermountain Medical Center, Murray, Utah, United States; University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States; National Heart Foundation Hospital and Research Institue; Christiana Care Health Services, Newark, Delaware, United States; Christiana Care, Glen Mills, Pennsylvania, United States; Aurora St Luke’s Medical Center, Milwaukee, Wisconsin, United States; London School of Hygiene and Tropical Medicine, London, United Kingdom; Ochsner Medical Center, New Orleans, Louisiana, United States; Eli Lilly and Company, Indianapolis, Indiana, United States; Daiichi Sankyo, Inc., Parsippany, New Jersey, United States; Unknown, New York, New York, United States; Zena and Michael A. Weiner Cardiovascular Institute at Mount Sinai School of Medicine, New York, New York, United States; Cedars Sinai Heart Institute, Los Angeles, California, United States BACKGROUND Prasugrel is a potent antiplatelet agent with limited uptake due to bleeding concerns. Comparison of clinical outcomes by type of acute coronary syndrome (ACS) can guide treatment strategies. We compared the associations between prasugrel or clopidogrel use for all clinical outcomes by type and severity of ACS.

TCT-111 Relationship between anemia, prasugrel use and clinical outcomes in contemporary percutaneous coronary intervention for acute coronary syndromes

Bleeding is a risk of potent antiplatelet therapy. Anemia is associated with increased bleeding. We sought to examine the rates of prasugrel use, thienopyridine switching and clinical outcomes by presence of anemia in contemporary percutaneous coronary intervention (PCI) for acute coronary syndrome