Association between high on-treatment platelet reactivity and occurrence of cerebral ischemic events in patients undergoing percutaneous coronary intervention

- Insufficient platelet inhibition increases the risk of cardiovascular ischemic events in patients after PCI.
- Genetic polymorphism CYP2C19*2 correlates with lower platelet inhibition.
- Carriers of CYP2C19*2/*2 allele showed an increased rate of ischemic cerebral events.

IntroductionPercutaneous coronary angioplasty (PCI) has become a routine treatment in symptomatic patients with coronary artery disease. The use of new generation drug eluting stents (DES) and dual antiplatelet therapy has significantly improved treatment outcomes and increased patients' safety by reducing the risk of stent thrombosis.AimsThe goal of this study was to assess whether high on treatment platelet reactivity (HTPR), despite clopidogrel treatment, measured with Multiplate Electrode Aggregometer (MEA) is associated with the risk of adverse ischemic cerebral events.MethodsSymptomatic patients with coronary artery disease admitted for coronary angiography and angioplasty (PCI) were consecutively enrolled in this study. 249 consecutive patients underwent coronary artery stenting for stable angina (n = 215) or non-ST-elevation acute coronary syndrome (n = 34). Inhibition of platelet aggregation was assessed by MEA. Genetic polymorphism of CYP2C19 was tested by HRM Real-Time PCR method in 150 patients.ResultsPatients with HTPR were more frequently diagnosed with ischemic stroke (p = 0.0351, OR = 16.818, 95% CI [1.464-193.23]) and other ischemic cerebral events (stroke or TIA, p = 0.0339, OR = 6.5, 95% CI [1.36-31.07]). Cumulative assessment of all ischemic and hemorrhagic events showed no statistical significance. Cerebral ischemic event was the only adverse event that correlated with CYP2C19 (*2/*2) allele (p = 0.0489, OR = 10; 95% CI [1.39-71.80]).ConclusionsHTPR assessed by MEA, in patients treated with clopidogrel after coronary artery stenting was found to be an important risk factor of ischemic cerebral events. In concordance, the carriers of CYP2C19*2/*2 allele showed an increased rate of ischemic cerebral events.