Association of Gene Polymorphisms in CYP2C19, platelet reactivity, and the SYNTAX score on 1-year clinical outcomes in patients undergoing percutaneous coronary intervention

Objective To investigate the association of polymorphisms in CYP2C19 , platelet reactivity , and the SYNTAX score on 1-Year major adverse cardiac events (MACE) in patients with acute coronary syndrome (ACS) undergoing primary percutaneous intervention (PCI) treated with clopidogrel . Material and Methods Out of 84 ACS patients enrolled, data of 72 patients were finalised for genetic analysis. 59 patients were on Clopidogrel and follow up done for one year. All patients undergoing primary PCI received aspirin 325 mg/day indefinitely and a 600-mg loading dose of Clopidogrel followed by 75 mg/day for 12 months. Platelet aggregation was determined using a platelet aggregometer (chronology). > 46 and <19 HPR (high platelet reactivity) and LPR in the setting of PCI have been defined by the (ROC) curve. Genetic analysis of CYP2C19 by PCR-RFLP technique was done. Syntax score (SS) was independently assessed by two experienced interventional cardiologists who were blinded to all other clinical data. Results HPR determined at 1 month was associated with significantly higher rates of MACE between 1 month and 1 year in patients in the upper SYNTAX score but not in those in the lower group. CYP2C19*2 was associated with HPR and it was not independently associated with the risk of MACE. Conclusion HPR is associated with increased rates of ischemic event only in patients with high SS suggesting a possible setting in which platelet function testing could be implemented to optimise antiplatelet therapy. CYP2C19*2was the only genetic variant significantly associated HPR but not associated with the risk of MACE.