Abstract 17933: Prognostic Impacts, Predictors and Genetic Determinants of High On-treatment Platelet Reactivity to Aspirin and Clopidogrel and in Patients Undergoing Elective PCI in Japanese Population
Introduction: Although Japanese people are said to more likely have High on-treatment platelet reactivity (HPR) due to genetic polymorphism compared to Caucasians, incidence of stent thrombosis is lower than other ethnicities, and prognostic impact of HPR in chronic phase of ischemic heart diseases is yet to be clarified.
Purpose: To investigate the prevalence and impacts of genetic polymorphism and HPR in chronic phase in Japanese population undergoing elective PCI.
Methods: Of 859 patients who underwent elective PCI at our institution and whose residual platelet reactivity was properly measured using VerifyNow aspirin (ARU) and P2Y12 (PRU) assays during September 2013 to March 2014 were included. As genetic determinants, SNPs of CYP2C19 and ABCB1 were analyzed.
Results: PRU as well as ARU were significantly higher in patients with history of stent thrombosis (ST) than in those without (PRU: 239.7±70.9 vs 278.5±47.8, p<0.05, ARU: 468.8±70.1 vs 512.4±63.0, p<0.05). All ST patients without HPR to clopidogrel showed HPR to aspirin. Although not significant, both PRU and ARU were tended to be higher in patients who developed MACE within 6 months from the index procedure compared to others. Prevalence of intermediate and poor metabolizer of clopidogrel was significantly higher in ST population compared to others (87% vs 63%, respectively). ABCB1 3435 TT homozygotes (16.2%) was not associated with HPR to clopidogrel by itself. Receiver operating characteristics curve suggested that PRU exceeding 271 in chronic phase increase the risk of ST (sensitivity 0.625, specificity 0.645, OR3.03, AUC: 0.66).
Conclusion: HPR to clopidogrel and aspirin was associated with increased risk of ST in Japanese population. Further analysis will be opened at the conference.
Author Disclosures: K. Fukino: None. T. Sat: None. M. Ishibashi: None. H. Yabushita: None. T. Warsawa: None. Y. Watanabe: None. S. Mitomo: None. T. Matsumoto: None. T. Naganuma: None. T. Sato: None. T. Kobayashi: None. Y. Fujino: None. K. Takagi: None. H. Ishiguro: None. S. Tahara: None. N. Kurita: None. S. Nakamura: None. K. Hozawa: None. S. Nakamura: None.
- © 2014 by American Heart Association, Inc.