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
Does the SYNTAX score help predict which patients with high platelet reactivity (HPR) will develop a major adverse cardiac event (MACE)?
A total of 1,053 patients with non–ST-segment elevation acute coronary syndrome (NSTEACS) undergoing percutaneous coronary intervention (PCI) and treated with clopidogrel were studied prospectively. Platelet reactivity index (PRI) was measured 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). MACE in the period between 1 month and 1 year was the primary endpoint.
One-month HPR was an independent predictor of MACE in patients with an SS ≥15, but not in those with an SS <15, displaying a fivefold increase in event rates (10.4% vs. 2.5%; p < 0.0001). CYP2C19*2 was the only single nucleotide polymorphism associated with HPR, but it was not associated with MACE. Predischarge HPR and SS effectively stratified the risk of subsequent MACE up to 1-year follow-up.
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.
The SYNTAX score is an angiographic grading tool to stratify the complexity of coronary disease. The utility of HPR in patients undergoing PCI is controversial. This study suggests that adding a measure of coronary disease complexity to platelet studies improves MACE prediction. More potent antiplatelet strategies may improve outcomes in this high-risk group, although this will need to be proven in future studies.
Keywords: Acute Coronary Syndrome, Follow-Up Studies, Polymorphism, Single Nucleotide, Ticlopidine, Blood Platelets, Percutaneous Coronary Intervention
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