Association between high on-treatment platelet reactivity and occurrence of cerebral ischemic events in patients undergoing percutaneous coronary intervention

Abstract Introduction Percutaneous coronary angioplasty (PCI) has become a routine treatment in symptomatic patients with coronary artery disease. The use of new generation drug eluting stents (DES) and dual antiplatelet therapy has significantly improved treatment outcomes and increased patients�...

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Published in:Thrombosis research 2016-02, Vol.138, p.49-54
Main Authors: Komosa, A, Siller-Matula, J.M, Lesiak, M, Michalak, M, Kowal, J, Mączyński, M, Siniawski, A, Mularek-Kubzdela, T, Wiśniewski, S, Grajek, S
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Aggregation
Antiplatelet therapy
Blood Platelets - drug effects
Brain Ischemia - etiology
Brain Ischemia - genetics
Clopidogrel
Coronary Artery Disease - surgery
Cytochrome P-450 CYP2C19 - genetics
Female
Hematology, Oncology and Palliative Medicine
Humans
Male
Middle Aged
Percutaneous Coronary Intervention - adverse effects
Platelet Aggregation - drug effects
Platelet Aggregation Inhibitors - therapeutic use
Platelet Function Tests
Polymorphism, Genetic
Risk Factors
Stroke
Ticlopidine - analogs & derivatives
Ticlopidine - therapeutic use
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Summary:Abstract Introduction Percutaneous coronary angioplasty (PCI) has become a routine treatment in symptomatic patients with coronary artery disease. The use of new generation drug eluting stents (DES) and dual antiplatelet therapy has significantly improved treatment outcomes and increased patients' safety by reducing the risk of stent thrombosis. Aims The goal of this study was to assess whether high on treatment platelet reactivity (HTPR), despite clopidogrel treatment, measured with Multiplate Electrode Aggregometer (MEA) is associated with the risk of adverse ischemic cerebral events. Methods Symptomatic patients with coronary artery disease admitted for coronary angiography and angioplasty (PCI) were consecutively enrolled in this study. 249 consecutive patients underwent coronary artery stenting for stable angina (n = 215) or non-ST-elevation acute coronary syndrome (n = 34). Inhibition of platelet aggregation was assessed by MEA. Genetic polymorphism of CYP2C19 was tested by HRM Real-Time PCR method in 150 patients. Results Patients with HTPR were more frequently diagnosed with ischemic stroke (p = 0.0351, OR = 16.818, 95% CI [1.464–193.23]) and other ischemic cerebral events (stroke or TIA, p = 0.0339, OR = 6.5, 95% CI [1.36–31.07]). Cumulative assessment of all ischemic and hemorrhagic events showed no statistical significance. Cerebral ischemic event was the only adverse event that correlated with CYP2C19 (*2/*2) allele (p = 0.0489, OR = 10; 95% CI [1.39–71.80]). Conclusions HTPR assessed by MEA, in patients treated with clopidogrel after coronary artery stenting was found to be an important risk factor of ischemic cerebral events. In concordance, the carriers of CYP2C19*2/*2 allele showed an increased rate of ischemic cerebral events.
ISSN:0049-3848
1879-2472
DOI:10.1016/j.thromres.2015.12.021