The relationship between on-clopidogrel platelet reactivity, genotype, and post-percutaneous coronary intervention outcomes in Chinese patients. (May 2015)

• Record Type: Journal Article
• Authors: Tang, Ning; Yin, Shiyu; Sun, Ziyong; Xu, Xiangdong; Qin, Jin
• Is Part Of: Scandinavian journal of clinical & laboratory investigation. Volume 75:Number 3(2015)
• Page Start: 223
• Page End: 229
• Publication Date: 2015-05
• Subjects: Acute coronary syndrome -- clopidogrel -- CYP2C19 -- platelet function assay; Clinical biochemistry -- Periodicals; Physiology, Pathological -- Periodicals; Physiology, Experimental -- Periodicals; Medicine -- Research -- Periodicals; Clinical medicine -- Periodicals; 616.0072
• DOI: 10.3109/00365513.2014.993696
• Languages: English
• ISSNs: 0036-5513

Abstract

Abstract: Background . High on-clopidogrel platelet reactivity reflects a poor response to clopidogrel and is associated with ischemic events, which has been attributed to several factors such as demographic, clinical characteristics and a polymorphism of CYP2C19 . Some new platelet assays monitoring on-clopidogrel platelet reactivity are currently available in China, but their relevance to the CYP2C19 genotype and post-percutaneous coronary intervention outcomes remain to be elucidated. Methods . Patients were prospectively included if they had a successful percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) and received clopidogrel and aspirin. CYP2C19 loss-of function genotype, adenosine diphosphate (ADP)-induced maximum platelet aggregation rate (MPAADP ) measured by light transmittance aggregometry, ADP-induced platelet-fibrin clot strength (MAADP ) measured by thrombelastography, platelet reactivity index (PRI) measured by vasodilator-stimulated phosphoprotein phosphorylation (VASP), and the occurrence of 6-month major adverse cardiovascular events (MACE) were assessed in 178 patients. Results . High on-treatment platelet reactivity prevalence defined by MPAADP > 46.0%, MAADP > 47 mm and PRI > 50.0% was 27.0%, 24.2%, and 61.2%, respectively. ADP-specific assays (VASP PRI) differed according to CYP2C19 genotype, with a significant gene–dose effect (PMs > IMs > EMs, p < 0.05). Multivariate analysis showed MPAADP > 46.0% and MAADP > 47 mm to be independent predictors of MACE at 6 months. Conclusions . CYP2C19 loss-of function genotypes with the * 2 and/or * 3 allele are highly prevalent in the Chinese population and are associated with higher residual platelet reactivity. High on-treatment platelet reactivity defined by MPAADP or MAADP predicts an increased risk of MACE for ACS patients undergoing PCI.