Cytochrome P450 2C19 681G>A Polymorphism and High On-Clopidogrel Platelet Reactivity Associated With Adverse 1-Year Clinical Outcome of Elective Percutaneous Coronary Intervention With Drug-Eluting or Bare-Metal Stents
Dietmar Trenk, PhD*,*,
Willibald Hochholzer, MD*,
Martin F. Fromm, MD ,
Ligia-Emilia Chialda, MD,
Andreas Pahl, PhD,
Christian M. Valina, MD*,
Christian Stratz, MD*,
Peter Schmiebusch, MD*,
Hans-Peter Bestehorn, MD*,
Heinz Joachim Büttner, MD* and
Franz-Josef Neumann, MD*
* Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany
Institute of Experimental and Clinical Pharmacology and Toxicology, University of Erlangen-Nuremberg, Erlangen, Germany.
View larger version (13K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 1 ORs for High On-Clopidogrel Platelet Reactivity According to CYP2C19*2 Genotype
Odds ratios (ORs) with 95% confidence intervals for residual platelet aggregation (RPA) >14% after stimulation of platelet-rich plasma with adenosine diphosphate 5 µmol/l comparing patients (Pts) carrying at least 1 CYP2C19 *2 allelic variant with wild-type homozygotes before percutaneous coronary intervention (PCI) and pre-discharge with and without adjustment for baseline variables (Table 1), with a difference between carriers of the CYP2C19*2 allele and wild-type homozygotes at a value of p  0.20. Odds ratios and p values were derived from logistic regression models.
|
|
View larger version (28K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 2 Platelet Aggregation According to CYP2C19*2 Genotype
Residual platelet aggregation in response to adenosine diphosphate (ADP) 5 µmol/in 3 CYP2C19 genotypes at various time points, as indicated below the columns. The columns represent median with interquartile range. The p value was determined by Kruskal-Wallis-H test. ns = not significant; other abbreviations as in Figure 1.
|
|
View larger version (18K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 3 Cumulative Composite Incidence of Death and MI
Cumulative composite incidence of death and myocardial infarction (MI) from pre-discharge to 1 year in the 2 strata defined by pre-discharge RPA. Abbreviations as in Figure 1.
|
|
View larger version (19K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 4 Cumulative Composite Incidence of Death and MI in Subsets With and Without Placement of DES
Cumulative composite incidence of death and MI from pre-discharge to 1 year stratified by pre-discharge RPA in subsets with and without placement of drug-eluting stents (DES). BMS = bare-metal stent; MI = myocardial infarction; other abbreviations as in Figure 1.
|
|
|
