Abstract 15262: Antiplatelet Activity and Clinical Outcomes on CYP3A4-metabolized Statin in Percutaneous Coronary Intervention
Introduction: Statins primarily metabolized by cytochrome P450 3A4 (CYP3A4) reportedly reduce clopidogrel metabolism to active metabolite. Recent studies suggest that CYP 3A4-metabolized statins attenuate the anti-aggregatory effect of clopidogrel.
Hypothesis: We sought to assess the antiplatelet activity of a CYP 3A4 metabolized statin and its association with clinical outcomes during dual antiplatelet therapy following percutaneous coronary intervention (PCI).
Methods: Among 3,755 patients enrolled the HOST-ASSURE trial, 1,187 patients with both baseline and 1-month platelet reactivity unit (PRU) values assessed by VerifyNow P2Y12 assay were assigned to the CYP 3A4-metabolized statin group (n=725) or non-CYP 3A4-metabolized statin group (n=462) according to type of statins used. The co-primary outcome were the differences between baseline and 1-month follow-up of PRU value and the composite of cardiovascular death, recurrent MI, including stent thrombosis, any revascularization and cerebrovascular accident (CVA) during the follow-up period. We compared the outcomes between groups both in the propensity adjusted and matched cohorts.
Results: Mean difference of PRU values was not significant in the CYP 3A4-metabolized statin group (mean difference: -4±84, p=0.367) and was significant in the non-CYP 3A4-metabolized statin group (mean difference: -12±69, p=0.006) both in the propensity score adjusted and matched cohorts. Patients with high PRU value at baseline, irrespective of the type of used statins, were associated with a significant reduction in mean difference of PRU values both in the propensity score adjusted (mean difference: -53.35, p<0.001) and matched cohort (mean difference: -41.57, p<0.001). The composite of clinical events did not differ between groups both in the propensity score adjusted (hazard ratio [HR] 0.962, 95% confidence interval [CI] 0.621-1.489, p=0.861) and matched (HR 0.902, 95% CI 0.554-1.468, p=0.678) cohorts.
Conclusions: This study showed that a CYP 3A4-metabolized statin slightly reduces antiplatelet activity of clopidogrel during dual antiplatelet therapy but did not increase clinical events in patients following PCI.
Author Disclosures: J. Park: None. K. Cha: None. J. Choi: None. B. Kim: None. H. Lee: None. J. Oh: None. H. Lee: None. T. Hong: None. H. Kim: None.
- © 2015 by American Heart Association, Inc.