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Association between high on-treatment platelet reactivity and occurrence of cerebral ischemic events in patients
A Komosa1, J M Siller-Matula2, M Lesiak1
11st Department of Cardiology, Poznan University of Medical Sciences, Poland.
Insights
High on-treatment platelet reactivity (HTPR) despite clopidogrel treatment increases the risk of ischemic cerebral events in patients undergoing coronary stenting. CYP2C19*2/*2 allele carriers also face a higher risk of these events.
Area of Science:
- Cardiology
- Pharmacogenomics
- Interventional Cardiology
Background:
- Percutaneous coronary angioplasty (PCI) with drug-eluting stents (DES) and dual antiplatelet therapy are standard for coronary artery disease.
- Newer DES and antiplatelet strategies have improved outcomes and reduced stent thrombosis risk.
Purpose of the Study:
- To determine if high on-treatment platelet reactivity (HTPR) during clopidogrel therapy is linked to ischemic cerebral events.
- To investigate the association between HTPR, measured by Multiplate Electrode Aggregometer (MEA), and adverse cerebral events.
Main Methods:
- 249 patients with coronary artery disease undergoing PCI for stable angina or acute coronary syndrome were enrolled.
- Platelet aggregation was assessed using MEA, and CYP2C19 genetic polymorphism was analyzed in 150 patients via HRM Real-Time PCR.
Main Results:
- Patients with HTPR had a significantly higher incidence of ischemic stroke (OR=16.8) and other cerebral ischemic events (OR=6.5).
- The CYP2C19*2/*2 allele was associated with an increased risk of cerebral ischemic events (OR=10).
- No statistical significance was found for the cumulative assessment of all ischemic and hemorrhagic events.
Conclusions:
- HTPR, measured by MEA, is a significant risk factor for ischemic cerebral events in patients treated with clopidogrel post-coronary stenting.
- CYP2C19*2/*2 allele carriers exhibit an elevated rate of ischemic cerebral events, reinforcing the genetic influence on treatment response.
Introduction:
Percutaneous coronary angioplasty (PCI) has become a routine treatment in symptomatic patients with coronary artery disease. The use of new generation drug eluting stents (DES) and dual antiplatelet therapy has significantly improved treatment outcomes and increased patients' safety by reducing the risk of stent thrombosis.
Aims:
The goal of this study was to assess whether high on treatment platelet reactivity (HTPR), despite clopidogrel treatment, measured with Multiplate Electrode Aggregometer (MEA) is associated with the risk of adverse ischemic cerebral events.
Methods:
Symptomatic patients with coronary artery disease admitted for coronary angiography and angioplasty (PCI) were consecutively enrolled in this study. 249 consecutive patients underwent coronary artery stenting for stable angina (n=215) or non-ST-elevation acute coronary syndrome (n=34). Inhibition of platelet aggregation was assessed by MEA. Genetic polymorphism of CYP2C19 was tested by HRM Real-Time PCR method in 150 patients.
Results:
Patients with HTPR were more frequently diagnosed with ischemic stroke (p=0.0351, OR=16.818, 95% CI [1.464-193.23]) and other ischemic cerebral events (stroke or TIA, p=0.0339, OR=6.5, 95% CI [1.36-31.07]). Cumulative assessment of all ischemic and hemorrhagic events showed no statistical significance. Cerebral ischemic event was the only adverse event that correlated with CYP2C19 (*2/*2) allele (p=0.0489, OR=10; 95% CI [1.39-71.80]).
Conclusions:
HTPR assessed by MEA, in patients treated with clopidogrel after coronary artery stenting was found to be an important risk factor of ischemic cerebral events. In concordance, the carriers of CYP2C19*2/*2 allele showed an increased rate of ischemic cerebral events.
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