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Genotyping, platelet reactivity and cardiovascular prognosis in patients after percutaneous coronary intervention receiving dual antiplatelet therapy

Session Best Posters session 1

Speaker Evangelos Oikonomou

Event : ESC Congress 2015

  • Topic : hypertension
  • Sub-topic : Hypertension – Treatment
  • Session type : Best ePosters

Authors : G Siasos (Athens,GR), M Zaromytidou (Athens,GR), S Kioufis (Athens,GR), E Oikonomou (Athens,GR), K Mourouzis (Athens,GR), S Tsalamandris (Athens,GR), M Anastasiou (Athens,GR), E Dimitropoulos (Athens,GR), M Vavuranakis (Athens,GR), D Tousoulis (Athens,GR)

Authors:
G. Siasos1 , M. Zaromytidou1 , S. Kioufis1 , E. Oikonomou1 , K. Mourouzis1 , S. Tsalamandris1 , M. Anastasiou1 , E. Dimitropoulos1 , M. Vavuranakis1 , D. Tousoulis1 , 1University of Athens Medical School, 1st Cardiology Department, “Hippokration” Hospital - Athens - Greece ,

Citation:
European Heart Journal ( 2015 ) 36 ( Abstract Supplement ), 40-41

Background: Individual platelet response to antiplatelet therapy depends on genetic, cellular and clinical factors. CYP2C19 and P2Y12 receptor polymorphisms are implicated in platelet response to antiplatelet treatment.

Purpose: To evaluate the impact of CYP2C19 and C34T P2Y12 genotyping on platelet reactivity and cardiovascular outcome in patients after percutaneous coronary intervention (PCI) receiving clopidogrel treatment.

Methods: We enrolled 408 patients with stable coronary artery disease (CAD) receiving aspirin and clopidogrel (75mg/d), one month after PCI. High on treatment platelet reactivity was evaluated using VerifyNow Assay. VerifyNow reports its results in P2Y12 reaction units (PRU) and the diagnostic cut-off value is 230 PRU. CYP2C19*2 and C34T P2Y12 genotyping was performed by real-time polymerase chain reaction. The primary end point was the composite of death or hospitalization for cardiovascular causes and patients were followed for a mean time of 14 months.

Results: In the total study population, 37% were carriers of at least one CYP2C19*2 reduced-function allele and 53% were carriers of at least one C34T reduced-function allele. Interestingly, carriers of two CYP2C19*2 reduced-function allele had significantly increased PRU (292±53 vs. 198±83, p=0.007). On the contrary, PRU did not differ between carriers and non-carriers of the C34T-allele (199±91 vs. 208±80, p=0.41). Moreover, although the rate of occurrence of primary end point differ significantly between carriers and non carriers of CYP2C19*2 (for carriers HR=1.96, 95%C.I. 1.05 to 3.66, p=0.03), C34T polymorphism had no impact on cardiovascular outcome (for carriers HR: 1.61, 95% CI 0.82 to 3.18, p=0.17).

Conclusions: We documented a different effect of CYP2C19 and P2Y12 receptor polymorphisms, on platelet reactivity and cardiovascular outcome in CAD patients after PCI receiving clopidogrel treatment.

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