A Study on the Correlation Between MDR1 Polymorphism and Clopidogrel Resistance in Hui Patients Treated with Percutaneous Coronary Intervention

Background: Clopidogrel anti-inflammatory effect and plaque burden are important factors for atherothrombotic process. Data are lacking on relationship of plaque burden and clopidogrel resistance in patients undergoing percutaneous coronary intervention (PCI) Methods: We identified 138 patients who had intravascular ultrasound during PCI between Jan 2007 to June 2007. Using the Verify Now Point-of-care assay, P2Y12 platelet reaction units (PRU) and percent inhibition of platelet activation (IPA) were measured 16 –24 hours after the loading dose of clopidogrel (600mg for patients not on clopidogrel daily, and 300mg for patients on clopidogrel 75mg daily) but before the next day of clopidogrel dose. CR was defined as PRU >200 or as IPA<10% or <20%. Results: Mean age of patients was 66±11 years and 74% were males. PRU>200 was found in 53 patients (38.4%) and PRU ≤200 in 85 patients (61.6%). Presence of myocardial infarction, hyperlipidemia, renal disease, smoking history, stable or unstable angina at admission were similar between the PRU groups and between IPA groups. Hypertension, diabetes, older age and reference site plaque burden were higher in clopidogrel resistance (Table ). With use of alternative definitions, reference segment plaque burden was also higher in clopidogrel resistance patients: 0.50±0.12 vs 0.41±0.13 in <10% vs ≥10% platelet inhibition (p=0.05), and 0.49±0.12 vs 0.41±0.13 in <20% vs ≥20% platelet inhibition (p=0.03) Conclusion: Clopidogrel resistance patients have more high risk baseline characteristics and higher plaque burden at the reference vessel segment, implying diffuse intracoronary atherosclerosis compared to clopidogrel sensitive patients who underwent PCI

Download Full-text

A Comparison of INNOVANCE® PFA P2Y and VerifyNow P2Y12 Assay for the Assessment of Clopidogrel Resistance in Patients Undergoing Percutaneous Coronary Intervention

Journal of Clinical Laboratory Analysis ◽

10.1002/jcla.21515 ◽

2012 ◽

Vol 26 (4) ◽

pp. 262-266 ◽

Cited By ~ 7

Author(s):

Jiyoung Jang ◽

Jihyang Lim ◽

Kiyuk Chang ◽

Yonggoo Kim ◽

Myungshin Kim ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

Clopidogrel Resistance ◽

Percutaneous Coronary

Download Full-text

Abstract 4487: Clopidogrel Resistance in Patients Undergoing Percutaneous Coronary Intervention: One Year Outcome

Circulation ◽

10.1161/circ.118.suppl_18.s_898-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Amala Chirumamilla ◽

Roxana Mehran ◽

Giora Weisz ◽

Somjot S Brar ◽

LeRoy Rabbani ◽

...

Keyword(s):

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Bypass Graft ◽

Coronary Intervention ◽

Mean Value ◽

Smoking History ◽

Clopidogrel Resistance ◽

Percutaneous Coronary ◽

Platelet Reaction

Background: Clopidogrel therapy is critical in patients undergoing percutaneous coronary intervention (PCI). Data are lacking on long term outcomes of clopidogrel resistance (CR) and its definition. Methods: We identified 389 patients who underwent PCI during a 6 month period. Using the VerifyNow Point-of-care assay, P2Y12 platelet reaction units (PRU) and percent inhibition of platelet activation (IPA) were measured 16 –24 hours after the loading dose of clopidogrel (600mg for patients not on clopidogrel daily, and 300mg for patients on clopidogrel 75mg daily) but before the next day clopidogrel dose. CR was defined as PRU >200, %IPA<10% or IPA<20%. Major adverse cardiac events (MACE) included death, myocardial infarction, coronary artery bypass graft surgery and unplanned repeat coronary revascularization. Results: Mean age of patients was 65±11 years, 24% females and 31% diabetics. PRU mean value is 173±93, IPA mean value=47.5±42, CR is found in PRU>200 =36%(140), IPA<10% =8%(31), IPA <20% = 16.4%(64) patients. Presence of myocardial infarction, hypertension, hyperlipidemia, renal disease, smoking history, stable or unstable angina at admission were similar between the PRU groups and between IPA groups. Diabetes and older age were more prevalent in clopidogrel resistance patients. 1-year MACE rates are shown below. Conclusion: Clopidogrel resistance is an important predictor of long-term MACE in patients undergoing PCI, particularly when defined as Platelet Reaction Units >200.

Download Full-text