Racial disparity with on-treatment platelet reactivity in patients undergoing percutaneous coronary intervention.
Racial disparity with on-treatment platelet reactivity in patients undergoing percutaneous coronary intervention.
Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
BACKGROUND: On-treatment platelet reactivity to clopidogrel is variable and in part genetic dependent. In African American (AA) patients, the relation between on-treatment platelet reactivity to clopidogrel and the factors that influence this interaction is unknown. The present study aims to evaluate on-treatment platelet reactivity to clopidogrel in AA patients and its interaction to race and CYP2C19*2 loss of function mutation. CONCLUSIONS: African American patients undergoing percutaneous coronary intervention not only have a higher prevalence of HTPR to clopidogrel but also have higher CYP2C19*2 allele carrier status compared with whites. Careful selection of antiplatelet agents should be considered in an AA population at higher risk for ischemic complications. Copyright 2013 Mosby, Inc. All rights reserved. METHODS: The study cohort included 289 consecutive patients presenting for percutaneous coronary intervention who were entered into a prospective observational registry. High on-treatment platelet reactivity (HTPR) was defined as P2Y12 reaction units (PRU) >=208 with VerifyNow P2Y12 assay and >50% by vasodilator-stimulated phosphoprotein phosphorylation assay platelet reactivity index (VASP PRI) measured 6 to 24 hours postprocedure. CYP2C19*2 (rs4244285) genotype was analyzed by real-time polymerase chain reaction. RESULTS: The prevalence of HTPR by both PRU (56% vs 35%, P = .003) and VASP PRI (67% vs 45%, P = .002) is more common in AAs compared with whites, respectively. African American patients had higher on-treatment mean PRU (207 +/- 110 vs 160 +/- 102, P = .002) and VASP PRI (49 +/- 26 vs 38 +/- 26, P = .004). African Americans also had a higher prevalence of CYP2C19*2 allele carrier status compared with whites (43% vs 29%, P = .04). African American race (P = .008) and CYP2C19*2 allele status (P = .02) independently had significant effects on PRU and VASP. Multivariable logistic regression analysis has shown that both CYP2C19*2 allele carrier status and AA race were independent correlates of HTPR for PRU >=208.
English
0002-8703
*African Americans/ge [Genetics]
*Aryl Hydrocarbon Hydroxylases/ge [Genetics]
*Blood Platelets/de [Drug Effects]
*Percutaneous Coronary Intervention
*Platelet Aggregation Inhibitors/pd [Pharmacology]
*Ticlopidine/aa [Analogs & Derivatives]
Aged
Female
Humans
Logistic Models
Male
Middle Aged
Mutation
Platelet Aggregation Inhibitors/tu [Therapeutic Use]
Platelet Function Tests
Polymorphism, Genetic
Ticlopidine/pd [Pharmacology]
Ticlopidine/tu [Therapeutic Use]
MedStar Health Research Institute
MedStar Heart & Vascular Institute
Journal Article
Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
BACKGROUND: On-treatment platelet reactivity to clopidogrel is variable and in part genetic dependent. In African American (AA) patients, the relation between on-treatment platelet reactivity to clopidogrel and the factors that influence this interaction is unknown. The present study aims to evaluate on-treatment platelet reactivity to clopidogrel in AA patients and its interaction to race and CYP2C19*2 loss of function mutation. CONCLUSIONS: African American patients undergoing percutaneous coronary intervention not only have a higher prevalence of HTPR to clopidogrel but also have higher CYP2C19*2 allele carrier status compared with whites. Careful selection of antiplatelet agents should be considered in an AA population at higher risk for ischemic complications. Copyright 2013 Mosby, Inc. All rights reserved. METHODS: The study cohort included 289 consecutive patients presenting for percutaneous coronary intervention who were entered into a prospective observational registry. High on-treatment platelet reactivity (HTPR) was defined as P2Y12 reaction units (PRU) >=208 with VerifyNow P2Y12 assay and >50% by vasodilator-stimulated phosphoprotein phosphorylation assay platelet reactivity index (VASP PRI) measured 6 to 24 hours postprocedure. CYP2C19*2 (rs4244285) genotype was analyzed by real-time polymerase chain reaction. RESULTS: The prevalence of HTPR by both PRU (56% vs 35%, P = .003) and VASP PRI (67% vs 45%, P = .002) is more common in AAs compared with whites, respectively. African American patients had higher on-treatment mean PRU (207 +/- 110 vs 160 +/- 102, P = .002) and VASP PRI (49 +/- 26 vs 38 +/- 26, P = .004). African Americans also had a higher prevalence of CYP2C19*2 allele carrier status compared with whites (43% vs 29%, P = .04). African American race (P = .008) and CYP2C19*2 allele status (P = .02) independently had significant effects on PRU and VASP. Multivariable logistic regression analysis has shown that both CYP2C19*2 allele carrier status and AA race were independent correlates of HTPR for PRU >=208.
English
0002-8703
*African Americans/ge [Genetics]
*Aryl Hydrocarbon Hydroxylases/ge [Genetics]
*Blood Platelets/de [Drug Effects]
*Percutaneous Coronary Intervention
*Platelet Aggregation Inhibitors/pd [Pharmacology]
*Ticlopidine/aa [Analogs & Derivatives]
Aged
Female
Humans
Logistic Models
Male
Middle Aged
Mutation
Platelet Aggregation Inhibitors/tu [Therapeutic Use]
Platelet Function Tests
Polymorphism, Genetic
Ticlopidine/pd [Pharmacology]
Ticlopidine/tu [Therapeutic Use]
MedStar Health Research Institute
MedStar Heart & Vascular Institute
Journal Article