Impact of gene polymorphisms, platelet reactivity, and the SYNTAX score on 1-year clinical outcomes in patients with non-ST-segment elevation acute coronary syndrome undergoing percutaneous coronary intervention: The GEPRESS study

Tullio Palmerini, Paolo Calabrò, Federico Piscione, Stefano De Servi, Marco Cattaneo, Diego Maffeo, Anna Toso, Antonio Bartorelli, Cataldo Palmieri, Marco De Carlo, Davide Capodanno, Chiara Barozzi, Luciana Tomasi, Diego Della Riva, Andrea Mariani, Nevio Taglieri, Letizia Bacchi Reggiani, Renatomaria Bianchi, Roberta De Rosa, Matteo MarianiGianmarco Podda, Philippe Généreux, Gregg W. Stone, Dominick J. Angiolillo

Research output: Contribution to journalArticle

Abstract

Objectives The aim of this study was to investigate the association between high on-treatment platelet reactivity (HPR) and the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score (SS) for risk prediction of major adverse cardiovascular events (MACE) in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) undergoing percutaneous coronary intervention (PCI).

Background Platelet function testing may be used to optimize antiplatelet therapy in high-risk patients, but identification of this category of patients remains challenging.

Methods The GEPRESS (Gene Polymorphism, Platelet Reactivity, and the Syntax Score) study was a prospective, multicenter, observational study enrolling 1,053 patients with NSTEACS undergoing PCI and treated with clopidogrel. The platelet reactivity index (PRI) was measured at 3 time points: before PCI, at hospital discharge, and 1 month after PCI. Genetic variants of clopidogrel metabolism were determined in 750 patients. Patients were stratified by the presence of HPR (PRI >50%) and by tertile of the SS (upper SS tertile ≥15). The primary objective of this study was the risk of MACE in the period between 1 month and 1 year.

Results Between 1 month and 1 year, 1-month HPR was an independent predictor of MACE in patients with an SS ≥15, but not in those with an SS

Conclusions In clopidogrel-treated patients with NSTEACS undergoing PCI, HPR was independently associated with an increased risk of MACE only in the presence of a high SS.

Original languageEnglish
Pages (from-to)1117-1127
Number of pages11
JournalJACC: Cardiovascular Interventions
Volume7
Issue number10
DOIs
Publication statusPublished - Oct 1 2014

Keywords

  • clopidogrel
  • platelet reactivity
  • SYNTAX score

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

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    Palmerini, T., Calabrò, P., Piscione, F., De Servi, S., Cattaneo, M., Maffeo, D., Toso, A., Bartorelli, A., Palmieri, C., De Carlo, M., Capodanno, D., Barozzi, C., Tomasi, L., Della Riva, D., Mariani, A., Taglieri, N., Reggiani, L. B., Bianchi, R., De Rosa, R., ... Angiolillo, D. J. (2014). Impact of gene polymorphisms, platelet reactivity, and the SYNTAX score on 1-year clinical outcomes in patients with non-ST-segment elevation acute coronary syndrome undergoing percutaneous coronary intervention: The GEPRESS study. JACC: Cardiovascular Interventions, 7(10), 1117-1127. https://doi.org/10.1016/j.jcin.2014.04.020