Association of Race and Ethnicity With High-Potency P2Y12 Inhibitors Prescription Among Patients With Acute MI
Hend Mansoor1, Rebecca Young2,3, Lisa A Kaltenbach2,3
1Department of Pharmacy Practice and Science (H.M.), University of Kentucky, Lexington.
Insights
Black and Hispanic patients with myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) were less likely to receive high-potency P2Y12 inhibitors upon discharge. This disparity persists regardless of socioeconomic status, indicating a need for equitable care in AMI pharmacotherapy.
Area of Science:
- Cardiovascular Medicine
- Health Disparities Research
- Pharmacotherapy Outcomes
Background:
- Racial and ethnic disparities are documented in post-acute myocardial infarction (AMI) care.
- High-potency P2Y12 inhibitors are guideline-recommended (Class I) for patients with AMI undergoing percutaneous coronary intervention (PCI).
Purpose of the Study:
- To investigate racial and ethnic disparities in the prescription of high-potency P2Y12 inhibitors at discharge for AMI patients who underwent PCI.
Main Methods:
- Analysis of consecutive patients with AMI undergoing PCI from the NCDR Cath PCI registry (April 2018 - June 2023).
- Logistic regression models were used to assess the likelihood of high-potency P2Y12 inhibitor discharge prescription, adjusted for social deprivation and patient/procedure variables.
Main Results:
- Among 1,662,387 patients, 9.9% were Black, 3.5% Asian, and 78.3% White; 8.1% were Hispanic.
- 52.7% of patients received a high-potency P2Y12 inhibitor at discharge.
- Black patients (aOR 0.93) and Hispanic patients (aOR 0.95) were less likely to receive these inhibitors compared to White and non-Hispanic patients, respectively. Asian patients were more likely (aOR 1.08).
Conclusions:
- Significant racial and ethnic disparities exist in the discharge prescription of high-potency P2Y12 inhibitors for AMI patients post-PCI, even after accounting for socioeconomic status.
- These findings underscore the need to address inequities in guideline-directed pharmacotherapy for AMI to improve patient outcomes.
Background:
Racial and ethnic disparities exist in postacute myocardial infarction (AMI) care. High-potency P2Y12 inhibitors use among patients with AMI who undergo percutaneous coronary intervention (PCI) carries a class I indication in the guidelines. This study aims to examine racial and ethnic differences in high-potency P2Y12 inhibitor prescription on discharge among patients with AMI undergoing PCI.
Methods:
Using data from the NCDR Cath PCI registry, we identified consecutive patients with AMI who underwent PCI from April 2018 to June 2023. Likelihood of high-potency P2Y12 inhibitor prescription on discharge was assessed using logistic regression models adjusted for social deprivation index and other patient- and procedure-related variables.
Results:
Among 1 662 387 patients hospitalized with AMI and who underwent PCI, 165 579 (9.9%) were Black, 58 595 (3.5%) were Asian, and 1 302 576 (78.3%) were of White race, while 135 637 (8.1%) were of Hispanic ethnicity. At discharge 876 078 (52.7%) were prescribed a high-potency P2Y12 inhibitor. Compared with White patients, Black patients were less likely (adjusted odds ratio, 0.93 [95% CI, 0.92-0.94]), while Asians were more likely (adjusted odds ratio, 1.08 [1.07-1.10]) to have a high-potency P2Y12 inhibitor discharge prescription. Compared with non-Hispanics, Hispanic patients were less likely to have a high-potency P2Y12 inhibitor discharge prescription (adjusted odds ratio, 0.95 [95% CI, 0.93-0.96).
Conclusions:
In a contemporary national registry of hospitalized patients with AMI who underwent PCI, Black and Hispanic patients were less likely to be discharged on a high-potency P2Y12 inhibitor irrespective of socioeconomic status. These findings highlight an opportunity to achieve equity in guideline-directed AMI pharmacotherapies to improve outcomes.
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