TY - JOUR
T1 - Racial disparity with on-treatment platelet reactivity in patients undergoing percutaneous coronary intervention
AU - Pendyala, Lakshmana K.
AU - Torguson, Rebecca
AU - Loh, Joshua P.
AU - Devaney, Joseph M.
AU - Chen, Fang
AU - Kitabata, Hironori
AU - Minha, Sa'Ar
AU - Barbash, Israel M.
AU - Suddath, William O.
AU - Satler, Lowell F.
AU - Pichard, Augusto D.
AU - Waksman, Ron
PY - 2013/8
Y1 - 2013/8
N2 - 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. 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. 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.
AB - 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. 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. 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.
UR - http://www.scopus.com/inward/record.url?scp=84880919871&partnerID=8YFLogxK
U2 - 10.1016/j.ahj.2013.04.008
DO - 10.1016/j.ahj.2013.04.008
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C2 - 23895809
AN - SCOPUS:84880919871
SN - 0002-8703
VL - 166
SP - 266
EP - 272
JO - American Heart Journal
JF - American Heart Journal
IS - 2
ER -
