Key result
Adjunctive 14-day cilostazol added to DAPT significantly reduced P2Y12 reaction unit levels at 14 days post-PCI in AMI patients with the CYP2C19 reduced-function allele compared to DAPT alone.
Why the study?
Does adjunctive cilostazol therapy tailored to CYP2C19 genotype improve platelet inhibition and biomarkers in AMI patients with the CYP2C19 reduced-function allele undergoing primary PCI?
RCT (n=128)
Open-label
Randomized
Yes
Does adjunctive cilostazol therapy tailored to CYP2C19 genotype improve platelet inhibition and biomarkers in AMI patients with the CYP2C19 reduced-function allele undergoing primary PCI?
Adjunctive cilostazol therapy tailored to CYP2C19 genotype improves platelet inhibition and reduces BNP levels in AMI patients with reduced-function alleles undergoing PCI.
Supports genotype-guided cilostazol addition post-AMI PCI; confirms enhanced platelet inhibition in CYP2C19 reduced-function carriers.
BACKGROUND: Patients with reduced-function CYP2C19 genotypes on dual antiplatelet therapy (DAPT) with aspirin and clopidogrel show higher clinical risk for acute myocardial infarction (AMI). We investigated the effect of CYP2C19 genotype-tailored adjunctive cilostazol therapy on treatment of AMI. METHODS AND RESULTS: P2Y12 system, and levels of biomarkers immediately after, and 1, 14, and 28 days after PCI. DAPT+Cilostazol reduced PRU levels in carriers (n=46) to those found in the Noncarrier/DAPT group (n=40), and significantly lower than those of the Carrier/DAPT group (n=42) at 14 days post-PCI. Discontinuation of cilostazol for 14 days was associated with a significant rise in PRU levels to those of the Carrier/DAPT group at 28 days post-PCI. Plasma B-type natriuretic peptide levels at 14 days post-PCI were lower in Carrier/DAPT+Cilostazol than in the other 2 groups, and the levels increased to those of the other groups at 28 days post-PCI after withdrawal of cilostazol. CONCLUSIONS: Adjunctive cilostazol therapy tailored to CYP2C19 genotype seemed useful in AMI patients with the CYP2C19 reduced-function allele.
No takes yet. Share an insight, caveat, or question.
Kaikita et al. (2018) conducted an RCT in Acute Myocardial Infarction (n=128). Cilostazol vs. DAPT alone was evaluated on P2Y12 reaction unit (PRU) levels at 14 days post-PCI (p=0.010). Adjunctive 14-day cilostazol added to DAPT significantly reduced P2Y12 reaction unit levels at 14 days post-PCI in AMI patients with the CYP2C19 reduced-function allele compared to DAPT alone.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: