New Research PaperCoronaryClinical Impact of CYP2C19 Genotype on Clopidogrel-Based Antiplatelet Therapy After Percutaneous Coronary Intervention
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Section snippets
Study population
The PTRG-DES (Platelet function and genoType-Related long-term proGnosis in DES-treated patients) consortium comprises of 9 prospective registries from 32 Korean academic centers, endorsed by the Korean Society of Interventional Cardiology.22 The participating registries and centers are listed in Supplemental Table 1. It was specifically designed to determine the relationship between platelet reactivity/genotyping and subsequent clinical events in East Asian patients with coronary artery
Baseline characteristics
The baseline characteristics are described in Table 1 and Supplemental Table 4. Of 8,163 patients with CYP2C19 genotyping and clopidogrel-based antiplatelet therapy after DES implantation, 3,098 (37.9%) patients were RMs or NMs, 3,906 (47.9%) patients were IMs, and 1,159 (14.2%) were PMs. The mean age of the study population was 64.2 ± 10.8 years, 65.1% were men, and 56.7% presented with ACS. There was no significant difference in demographics, cardiovascular risk factors, or laboratory
Discussion
The present study evaluated the prognostic impact of CYP2C19 genotyping for clopidogrel-based antiplatelet therapy among East Asian patients with stable IHD or ACS after DES implantation using a nationwide and multicenter consortium. The major findings were as follows: 1) only 37.9% of the patients in Korea were RMs or NMs; 2) PRU levels and the prevalence of HPR increased proportionally according to the number of CYP2C19 loss-of-function allele; 3) CYP2C19 genotyping could be helpful for
Conclusions
In this large real-world data composing East Asians who underwent DES implantation and clopidogrel-based antiplatelet therapy, IMs or PMs showed a higher risk of cardiac death, myocardial infarction, and stent thrombosis at 5-year follow-up compared with RMs or NMs. The prognostic implication of CYP2C19 genotyping was more evident for patients with ACS than for those with stable IHD or in the early phase (within 1 year) after DES implantation. De-escalation to clopidogrel monotherapy should be
Funding Support and Author Disclosures
The study was sponsored by the Platelet-Thrombosis Research Group under the Korean Society of Intervention Cardiology. Dr Jeong has received honoraria for lectures from AstraZeneca, Daiichi Sankyo, Sanofi, Han-mi Pharmaceuticals, and Yuhan Pharmaceuticals; and research grants or support from Yuhan Pharmaceuticals and U&I Corporation. Dr Joo has received honoraria for lectures from AstraZeneca, Hanmi, Samjin, Dong-A, HK inno. N Pharmaceuticals, and DIO Medical Ltd. Dr Song has received honoraria
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Drs Lee and Jeong contributed equally to this work.