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 Mariani & 4 others Gianmarco Podda, Philippe Genereux, Gregg W. Stone, Dominick J. Angiolillo

Research output: Contribution to journalArticle

32 Citations (Scopus)

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 <15, displaying a 5-fold 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. Although there was a significant variability in the PRI across the 1-month period, predischarge HPR and SS effectively stratified the risk of subsequent MACE up to 1-year follow-up.

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 (US)
Pages (from-to)1117-1127
Number of pages11
JournalJACC: Cardiovascular Interventions
Volume7
Issue number10
DOIs
StatePublished - Oct 1 2014

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Percutaneous Coronary Intervention
Acute Coronary Syndrome
clopidogrel
Blood Platelets
Genes
Taxus
Thoracic Surgery
Multicenter Studies
Observational Studies
Single Nucleotide Polymorphism
Therapeutics

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Palmerini, Tullio ; Calabrò, Paolo ; Piscione, Federico ; De Servi, Stefano ; Cattaneo, Marco ; Maffeo, Diego ; Toso, Anna ; Bartorelli, Antonio ; Palmieri, Cataldo ; De Carlo, Marco ; Capodanno, Davide ; Barozzi, Chiara ; Tomasi, Luciana ; Della Riva, Diego ; Mariani, Andrea ; Taglieri, Nevio ; Reggiani, Letizia Bacchi ; Bianchi, Renatomaria ; De Rosa, Roberta ; Mariani, Matteo ; Podda, Gianmarco ; Genereux, Philippe ; Stone, Gregg W. ; Angiolillo, Dominick J. / 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. In: JACC: Cardiovascular Interventions. 2014 ; Vol. 7, No. 10. pp. 1117-1127.
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title = "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",
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 <15, displaying a 5-fold 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. Although there was a significant variability in the PRI across the 1-month period, predischarge HPR and SS effectively stratified the risk of subsequent MACE up to 1-year follow-up.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.",
author = "Tullio Palmerini and Paolo Calabr{\`o} and Federico Piscione and {De Servi}, Stefano and Marco Cattaneo and Diego Maffeo and Anna Toso and Antonio Bartorelli and Cataldo Palmieri and {De Carlo}, Marco and Davide Capodanno and Chiara Barozzi and Luciana Tomasi and {Della Riva}, Diego and Andrea Mariani and Nevio Taglieri and Reggiani, {Letizia Bacchi} and Renatomaria Bianchi and {De Rosa}, Roberta and Matteo Mariani and Gianmarco Podda and Philippe Genereux and Stone, {Gregg W.} and Angiolillo, {Dominick J.}",
year = "2014",
month = "10",
day = "1",
doi = "10.1016/j.jcin.2014.04.020",
language = "English (US)",
volume = "7",
pages = "1117--1127",
journal = "JACC: Cardiovascular Interventions",
issn = "1936-8798",
publisher = "Elsevier Inc.",
number = "10",

}

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, LB, Bianchi, R, De Rosa, R, Mariani, M, Podda, G, Genereux, P, Stone, GW & Angiolillo, DJ 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, vol. 7, no. 10, pp. 1117-1127. https://doi.org/10.1016/j.jcin.2014.04.020

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

In: JACC: Cardiovascular Interventions, Vol. 7, No. 10, 01.10.2014, p. 1117-1127.

Research output: Contribution to journalArticle

TY - JOUR

T1 - 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

T2 - The GEPRESS study

AU - Palmerini, Tullio

AU - Calabrò, Paolo

AU - Piscione, Federico

AU - De Servi, Stefano

AU - Cattaneo, Marco

AU - Maffeo, Diego

AU - Toso, Anna

AU - Bartorelli, Antonio

AU - Palmieri, Cataldo

AU - De Carlo, Marco

AU - Capodanno, Davide

AU - Barozzi, Chiara

AU - Tomasi, Luciana

AU - Della Riva, Diego

AU - Mariani, Andrea

AU - Taglieri, Nevio

AU - Reggiani, Letizia Bacchi

AU - Bianchi, Renatomaria

AU - De Rosa, Roberta

AU - Mariani, Matteo

AU - Podda, Gianmarco

AU - Genereux, Philippe

AU - Stone, Gregg W.

AU - Angiolillo, Dominick J.

PY - 2014/10/1

Y1 - 2014/10/1

N2 - 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 <15, displaying a 5-fold 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. Although there was a significant variability in the PRI across the 1-month period, predischarge HPR and SS effectively stratified the risk of subsequent MACE up to 1-year follow-up.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.

AB - 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 <15, displaying a 5-fold 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. Although there was a significant variability in the PRI across the 1-month period, predischarge HPR and SS effectively stratified the risk of subsequent MACE up to 1-year follow-up.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.

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U2 - 10.1016/j.jcin.2014.04.020

DO - 10.1016/j.jcin.2014.04.020

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