Effects of genetic variants on platelet reactivity and one- year clinical outcomes after percutaneous coronary intervention: A prospective multicentre registry study
- Authors
- Joo, Hyung Joon; Ahn, Sung Gyun; Park, Jae Hyoung; Park, Ji Young; Hong, Soon Jun; Kim, Seok-Yeon; Choi, WoongGil; Gwon, HyeonCheol; Lim, Young-Hyo; Kim, Weon; Kang, Woong Chol; Cho, Yun-Hyeong; Kim, Yong Hoon; Yoon, JungHan; Shin, WonYong; Hong, Myeong-Ki; Garg, Scot; Jang, Yangsoo; Lim, Do-Sun
- Issue Date
- 19-Jan-2018
- Publisher
- NATURE PUBLISHING GROUP
- Citation
- SCIENTIFIC REPORTS, v.8
- Journal Title
- SCIENTIFIC REPORTS
- Volume
- 8
- URI
- https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/4157
- DOI
- 10.1038/s41598-017-18134-y
- ISSN
- 2045-2322
- Abstract
- Clopidogrel is the mainstay for antiplatelet treatment after percutaneous coronary intervention (PCI). The relationship of platelet reactivity and genetic polymorphism with clinical outcomes with newer-generation drug-eluting stents is unclear. We analysed 4,587 patients for the most powerful single-nucleotide polymorphisms (CYP2C19, CYP2C9, ABCB1, PON1, and P2Y12) related to on-treatment platelet reactivity (OPR). The optimal cut-off value of high OPR for major adverse thrombotic events was 266. CYP2C19 was significantly associated with high OPR and the number of CYP2C19*R (*2 or *3) alleles was proportional to the increased risk of high OPR. Death, myocardial infarction (MI), stroke, stent thrombosis, and bleeding events were assessed during a 1-year follow-up period. Primary endpoints were death and non-fatal MI. The cumulative 1-year incidence of death and stent thrombosis was significantly higher in patients with CYP2C19*2/*2, CYP2C19*2/*3, and CYP2C19*3/*3 (Group 3) than in patients with CYP2C19*1/*1 (Group 1). Multivariate Cox proportional hazard model showed that cardiac death risk was significantly higher in Group 3 than in Group 1 (hazard ratio 2.69, 95% confidence interval 1.154-6.263, p = 0.022). No association was reported between bleeding and OPR. Thus, CYP2C19 may exert a significant impact on the prognosis of PCI patients even in the era of newer-generation drug-eluting stents.
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