The impact of CYP2C19 genotype on the platelet reactivity index (PRI) among chronic coronary syndromes (CCS) patients undergoing percutaneous coronary intervention (PCI): Affectability of rapid genetic testing

Akkaif, Mohammed Ahmed, Daud, Nur Aizati Athirah, Noor, Dzul Azri Mohamed, Sha'aban, Abubakar ORCID: https://orcid.org/0000-0002-5491-9851, Kader, Muhamad Ali SK Abdul and Ibrahim, Baharudin 2024. The impact of CYP2C19 genotype on the platelet reactivity index (PRI) among chronic coronary syndromes (CCS) patients undergoing percutaneous coronary intervention (PCI): Affectability of rapid genetic testing. Cardiovascular Drugs and Therapy 10.1007/s10557-024-07544-6 Item availability restricted.

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Abstract

Background In the Asian population, the presence of the CYP2C19 loss-of-function (LOF) allele is a known genetic variation. This allele is associated with a reduced capacity to metabolize clopidogrel into its active forms through the CYP2C19 enzyme, resulting in diminished platelet inhibition and an elevated risk of recurrent cardiovascular events. Regulatory authorities have recommended an alternative P2Y12 inhibitor, ticagrelor, for individuals carrying the LOF allele. Consequently, this study seeks to assess the impact of the CYP2C19 genotype on the Platelet reactivity index (PRI) using a rapid genetic testing approach in Asian patients with chronic coronary syndromes (CCS) who undergo percutaneous coronary intervention (PCI). Methods This prospective study employed a parallel design, single-center design, and randomized approach. Genotyping for the CYP2C19*2 and *3 polymorphisms was conducted using the Nested Allele-Specific Multiplex PCR (NASM-PCR) technique. Patients meeting the inclusion criteria underwent genotyping for CYP2C19 polymorphisms. Following PCI, patients were randomly assigned to receive either ticagrelor or clopidogrel. PRI assessments were performed four hours after loading dose administration. The trial was registered with ClinicalTrials.gov under the identifier NCT05516784. Results Among the 94 patients recruited for the study, 40 (42.55%) were identified as carriers of the LOF allele for CYP2C19*2 and *3 (*1/*2, *2/*2, *1/*3). Out of the 84 patients evaluated for PRI (44 receiving clopidogrel and 40 receiving ticagrelor), 21 (47.7%) of the clopidogrel group and 39 (97.5%) of the ticagrelor group exhibited a favorable response to antiplatelet therapy (PRI < 50). Patients treated with ticagrelor demonstrated superior antiplatelet responses compared to those receiving clopidogrel, regardless of LOF carrier status (P = 0.005 and < 0.001 for non-LOF and LOF carriers, respectively). Conclusion NASM-PCR as a rapid genetic test holds promise for personalizing antiplatelet therapy in Asian CCS patients.

Item Type:	Article
Date Type:	Published Online
Status:	Published
Schools:	Medicine
Publisher:	Springer
ISSN:	0920-3206
Date of First Compliant Deposit:	6 September 2024
Date of Acceptance:	27 November 2023
Last Modified:	06 Nov 2024 19:00
URI:	https://orca.cardiff.ac.uk/id/eprint/171904

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