Background On-treatment platelet reactivity to clopidogrel is variable and in part genetic dependent. In African American (AA) patients, the relation between on-treatment platelet reactivity to clopidogrel and the factors that influence this interaction is unknown. The present study aims to evaluate on-treatment platelet reactivity to clopidogrel in AA patients and its interaction to race and CYP2C19*2 loss of function mutation. Methods The study cohort included 289 consecutive patients presenting for percutaneous coronary intervention who were entered into a prospective observational registry. High on-treatment platelet reactivity (HTPR) was defined as P2Y12 reaction units (PRU) ≥208 with VerifyNow P2Y12 assay and >50% by vasodilator-stimulated phosphoprotein phosphorylation assay platelet reactivity index (VASP PRI) measured 6 to 24 hours postprocedure. CYP2C19*2 (rs4244285) genotype was analyzed by real-time polymerase chain reaction. Results The prevalence of HTPR by both PRU (56% vs 35%, P =.003) and VASP PRI (67% vs 45%, P =.002) is more common in AAs compared with whites, respectively. African American patients had higher on-treatment mean PRU (207 ± 110 vs 160 ± 102, P =.002) and VASP PRI (49 ± 26 vs 38 ± 26, P =.004). African Americans also had a higher prevalence of CYP2C19*2 allele carrier status compared with whites (43% vs 29%, P =.04). African American race (P =.008) and CYP2C19*2 allele status (P =.02) independently had significant effects on PRU and VASP. Multivariable logistic regression analysis has shown that both CYP2C19*2 allele carrier status and AA race were independent correlates of HTPR for PRU ≥208. Conclusions African American patients undergoing percutaneous coronary intervention not only have a higher prevalence of HTPR to clopidogrel but also have higher CYP2C19*2 allele carrier status compared with whites. Careful selection of antiplatelet agents should be considered in an AA population at higher risk for ischemic complications. © 2013 Mosby, Inc.
CITATION STYLE
Pendyala, L. K., Torguson, R., Loh, J. P., Devaney, J. M., Chen, F., Kitabata, H., … Waksman, R. (2013). Racial disparity with on-treatment platelet reactivity in patients undergoing percutaneous coronary intervention. American Heart Journal, 166(2), 266–272. https://doi.org/10.1016/j.ahj.2013.04.008
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