Routine Assessment of On-Clopidogrel Platelet Reactivity and Gene Polymorphisms in Predicting Clinical Outcome Following Drug-Eluting Stent Implantation in Patients With Stable Coronary Artery Disease

被引：74

作者：

Anselmi, Chiara Viviani ^{[1
]}

Briguori, Carlo ^{[2
,3
]}

Roncarati, Roberta ^{[1
,4
]}

Papa, Laura ^{[1
]}

Visconti, Gabriella ^{[2
,3
]}

Focaccio, Amelia ^{[2
,3
]}

De Micco, Francesca ^{[2
,3
]}

Latronico, Michael V. G. ^{[5
]}

Pagnotta, Paolo ^{[5
]}

Condorelli, Gianluigi ^{[5
,6
]}

机构：

[1] Ist Ricovero & Cura Carattere Sci Multimed, Milan, Italy

[2] Clin Mediterranea, Lab Intervent Cardiol, I-80121 Naples, Italy

[3] Clin Mediterranea, Dept Cardiol, I-80121 Naples, Italy

[4] CNR, Ist Ric Genet & Biomed, I-20133 Milan, Italy

[5] Humanitas Clin & Res Ctr, Milan, Italy

[6] Univ Milan, Milan, Italy

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2013年 / 6卷 / 11期

关键词：

angioplasty; clopidogrel; genetics; negative outcome; platelet reactivity; predictive test; CHRONIC KIDNEY-DISEASE; OF-FUNCTION POLYMORPHISM; ANTIPLATELET THERAPY; CARDIOVASCULAR OUTCOMES; CYP2C19; GENOTYPE; RISK-ASSESSMENT; INTERVENTION; THROMBOSIS; EVENTS; EFFICACY;

D O I：

10.1016/j.jcin.2013.06.010

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives This study sought to assess the usefulness of clopidogrel-pathway genotyping and on-treatment platelet reactivity (OTR) testing in predicting major adverse cardiac events (MACE) in stable coronary artery disease (CAD) patients receiving drug-eluting stents (DES) under dual antiplatelet (clopidogrel plus aspirin) therapy. Background The role of pharmacogenetics and OTR in predicting MACE-death, myocardial infarction, or stent thrombosisdin stable CAD patients scheduled for DES implantation is still debated. Methods Patients with stable CAD treated by DES implantation (n = 1,432) were genotyped with a TaqMan OpenArray (Applied Biosystems, Carlsbad, California) and assessed for OTR with the VerifyNow P2Y(12) test (Accumetrics Inc., San Diego, California). Genes tested were ABCB1, CYP1A2, CYP2B6*9, CYP2C8*3, CYP2C9*2, CYP2C19, CYP3A4, CYP3A5*3, P2RY12, and PON1CYP2C19. High OTR was defined as P2Y12 reaction units >= 230. The endpoint at 12-month follow-up was MACE occurring during antiplatelet therapy. Results All groups that were stratified for loss-of-function variants of the cytochrome P450 gene CYP2C19 had significant hazard ratios (HR) for MACE (genotypic HR: 1.41, 95% confidence interval [CI]: 1.06 to 1.89, p = 0.01; allelic HR: 1.56, 95% CI: 2.26 to 1.2, p = 0.01). Variants of other clopidogrel-pathway genes were not significantly associated with MACE. When OTR was assessed, clinical significance was found only in high-risk diabetic (HR: 2.11, 95% CI: 1.29 to 3.45, p < 0.001) and chronic kidney disease (HR: 2.03, 95% CI: 1.03 to 4.02, p = 0.04) patients. Conclusions CYP2C19 metabolizer status is an independent predictor of MACE after DES implantation and can be used for prognostication in all stable CAD patients. High OTR, as assessed by the VerifyNow P2Y(12) test, is an independent predictor of MACE only for high-risk subsets, that is, patients with diabetes or chronic kidney disease. (C) 2013 by the American College of Cardiology Foundation

引用

页码：1166 / 1175

页数：10

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