Vol.:(0123456789) 1 3 Clinical Research in Cardiology https://doi.org/10.1007/s00392-019-01561-4 ORIGINAL PAPER Prasugrel use and clinical outcomes by age among patients undergoing PCI for acute coronary syndrome: from the PROMETHEUS study Jaya Chandrasekhar 1,2  · Usman Baber 1  · Samantha Sartori 1  · Melissa Aquino 1  · Kamilia Moalem 1  · Annapoorna S. Kini 3  · Sunil V. Rao 4  · William Weintraub 5  · Timothy D. Henry 6  · Birgit Vogel 1  · Zhen Ge 1  · Joseph B. Muhlestein 7  · Sandra Weiss 8  · Craig Strauss 9  · Catalin Toma 10  · Anthony DeFranco 11  · Bimmer E. Claessen 1  · Stuart Keller 12  · Brian A. Baker 13  · Mark B. Efron 12,14  · Stuart Pocock 15  · George Dangas 1  · Samir Kapadia 16  · Roxana Mehran 1 Received: 13 June 2019 / Accepted: 16 October 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2020 Abstract Background Prasugrel is a potent thienopyridine that may be preferentially used in younger patients with lower bleeding risk. Objective We compared prasugrel use and outcomes by age from the PROMETHEUS study. We also assessed age-related trends in treatment efects with prasugrel versus clopidogrel. Methods PROMETHEUS was a multicenter acute coronary syndrome (ACS) percutaneous coronary intervention (PCI) registry. We compared patients in age tertiles (T1 < 60 years, T2 60–70 years, T3 > 70 years). Major adverse cardiac events (MACE) were a composite of death, myocardial infarction, stroke or unplanned revascularization. Data were adjusted using multivariable Cox regression for age-related risks and propensity score stratifcation for thienopyridine efects. Results The study included 19,914 patients: 7045 (35.0%) in T1, 6489 (33.0%) in T2 and 6380 (32.0%) in T3. Prasugrel use decreased from T1 to T3 (29.2% vs. 23.5% vs. 7.5%, p < 0.001). Crude 1-year MACE rates were highest in T3 (17.4% vs. 16.8% vs. 22.7%, p < 0.001), but adjusted risk was similar between the groups (p-trend 0.52). Conversely, crude incidence (2.8% vs. 3.8% vs. 6.9%, p < 0.001) and adjusted bleeding risk were highest in T3 (HR 1.24, 95% CI 0.99–1.55 in T2; HR 1.83, 95% CI 1.46–2.30 in T3; p-trend < 0.001; reference = T1). Treatment efects with prasugrel versus clopidogrel did not demonstrate age-related trends for MACE (p-trend = 0.91) or bleeding (p-trend = 0.28). Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00392-019-01561-4) contains supplementary material, which is available to authorized users. * Roxana Mehran Roxana.mehran@mountsinai.org 1 Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA 2 Department of Clinical and Experimental Cardiology, Amsterdam UMC, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands 3 Mount Sinai Hospital, New York, NY, USA 4 Duke University, Durham, NC, USA 5 MedStar Washington Hospital Center, Washington, DC, USA 6 Cedars-Sinai Heart Institute, Los Angeles, CA, USA 7 Intermountain Heart Institute, Salt-Lake City, UT, USA 8 Christiana Care Health System, Newark, DE, USA 9 Minneapolis Heart Institute, Minneapolis, MN, USA 10 University of Pittsburgh Medical Center, Pittsburgh, PA, USA 11 Aurora Cardiovascular Services, Milwaukee, WI, USA 12 Eli Lilly and Company, Indianapolis, IN, USA 13 Daiichi Sankyo, Inc, Parsippany, NJ, USA 14 John Ochsner Heart and Vascular Center, Ochsner Medical Center, New Orleans, LA, USA 15 London School of Hygiene and Tropical Medicine, London, UK 16 Cleveland Clinic, Cleveland, OH, USA