Platelet Function and Genotype after DES Implantation in East Asian Patients: Rationale and Characteristics of the PTRG-DES Consortium
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Purpose: Platelet function test (PFT) results and genotype hold unique prognostic implications in East Asian patients. The aim ofthe PTRG-DES (Platelet function and genoType-Related long-term proGnosis in Drug-Eluting Stent-treated Patients with coronaryartery disease) consortium is to assess the clinical impact thereof on long-term clinical outcomes in Korean patients withcoronary artery disease during dual antiplatelet therapy (DAPT) including clopidogrel. Materials and Methods: Searching publications on the PubMed, we reviewed clopidogrel treatment studies with PFT and/orgenotype data for potential inclusion in this study. Lead investigators were invited to share PFT/genotype results, patient characteristics,and clinical outcomes to evaluate relationships among them. Results: Nine registries from 32 academic centers participated in the PTRG-DES consortium, contributing individual patient datafrom 13160 patients who underwent DES implantation between July 2003 and August 2018. The PTRG-PFT cohort was composedof 11714 patients with available VerifyNow assay results. Platelet reactivity levels reached 218±79 P2Y12 reaction units (PRU), and high on-clopidogrel platelet reactivity based on a consensus-recommended cutoff (PRU >208) was observed in 55.9%. The PTRGGenotypecohort consisted of 8163 patients with candidate genotypes related with clopidogrel responsiveness. Of those with cytochromeP450 (CYP) 2C19 genotype, frequencies of carrying one and two loss-of-function allele (s) (*2 or *3) were 47.9% (intermediatemetabolizers) and 14.2% (poor metabolizers), respectively. Conclusion: The PTRG-DES consortium highlights unique values for on-clopidogrel platelet reactivity and CYP2C19 phenotypethat may be important to developing optimal antiplatelet regimens in East Asian patients. Trial Registration: ClinicalTrials.gov Identifier: NCT04734028.
Abstract
Purpose: Platelet function test (PFT) results and genotype hold unique prognostic implications in East Asian patients. The aim ofthe PTRG-DES (Platelet function and genoType-Related long-term proGnosis in Drug-Eluting Stent-treated Patients with coronaryartery disease) consortium is to assess the clinical impact thereof on long-term clinical outcomes in Korean patients withcoronary artery disease during dual antiplatelet therapy (DAPT) including clopidogrel. Materials and Methods: Searching publications on the PubMed, we reviewed clopidogrel treatment studies with PFT and/orgenotype data for potential inclusion in this study. Lead investigators were invited to share PFT/genotype results, patient characteristics,and clinical outcomes to evaluate relationships among them. Results: Nine registries from 32 academic centers participated in the PTRG-DES consortium, contributing individual patient datafrom 13160 patients who underwent DES implantation between July 2003 and August 2018. The PTRG-PFT cohort was composedof 11714 patients with available VerifyNow assay results. Platelet reactivity levels reached 218±79 P2Y12 reaction units (PRU), and high on-clopidogrel platelet reactivity based on a consensus-recommended cutoff (PRU >208) was observed in 55.9%. The PTRGGenotypecohort consisted of 8163 patients with candidate genotypes related with clopidogrel responsiveness. Of those with cytochromeP450 (CYP) 2C19 genotype, frequencies of carrying one and two loss-of-function allele (s) (*2 or *3) were 47.9% (intermediatemetabolizers) and 14.2% (poor metabolizers), respectively. Conclusion: The PTRG-DES consortium highlights unique values for on-clopidogrel platelet reactivity and CYP2C19 phenotypethat may be important to developing optimal antiplatelet regimens in East Asian patients. Trial Registration: ClinicalTrials.gov Identifier: NCT04734028.
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