Association between peak neutrophil count, clopidogrel loading dose, and left ventricular systolic function in patients with primary percutaneous coronary intervention

Improvement of LVEF in patients with HFrEF with coronary heart disease after revascularization-A real-world study

OBJECTIVE

This study aimed to explore the predictive factors for left ventricular ejection fraction (LVEF) improvement after revascularization.

METHODS

This real-world study examined 993 patients with ischemic HFrEF who had received revascularization (PCI or CABG), had survived at least 90 days and had undergone an echocardiography review. Based on the change in the LVEF, we divided the patients into two groups.

RESULT

We obtained 454 patients with ≥10% improvement and 539 with <10% improvement or deterioration. By Cox regression analysis, we obtained five independent factors for LVEF improvement, including female (P = 0.018, OR 0.726, 95% CI 0.557-0.947), prior MI (P = 0.000, OR 0.590, 95% CI 0.476-0.732), LVEF (P = 0.008, OR 0.967, 95% CI 0.943-0.991), digoxin (P = 0.027, OR 0.708, 95% CI 0.521-0.961), loop diuretic (P = 0.000, OR 1.515, 95% CI 1.208-1.901), and triple-vessel disease (P = 0.000, OR 1.462, 95% CI 1.192-1.792). By multivariate generalized estimation, we obtained seven factors associated with the degree of improvement, namely, low LVEF, short LVESD, short LVEDD, no prior MI, no hyperuricemia, clopidogrel use and triple-vessel disease.

CONCLUSIONS

The method of revascularization (PCI vs CABG) had no effect on LVEF improvement. Patients with severely impaired baseline LVEFs, triple-vessel disease, or no history of MI tended to exhibit marked LVEF improvement (≥10%) after revascularization. In addition, LVESD, LVEDD, hyperuricemia, clopidogrel use and loop diuretic affected the degree of improvement.

Genetic polymorphisms of CYP2C19 2 and ABCB1 C3435T affect the pharmacokinetic and pharmacodynamic responses to clopidogrel in 401 patients with acute coronary syndrome

BACKGROUNDS AND OBJECTIVES

Clopidogrel, an inhibitor of platelet ADP P2Y12 receptors, plays an important role in the prevention of stent thrombosis. However, some patients do not attain adequate antiplatelet effects. Studies have shown that the genetic variation in CYP2C19*2 is associated with an impaired response to clopidogrel. This study was designed to investigate the genetic variants of 21 genes involving in the absorption, metabolism, and pharmacodynamics of clopidogrel. The effects of these genes on the plasma level of clopidogrel and its metabolites (active clopi-H4 and inactive CLPM) and platelet reactivity were also studied.

METHODS AND RESULTS

401 acute coronary syndrome (ACS) patients received either a 300 mg loading dose following 75 mg maintenance dose daily or a 75mg maintenance dose daily of clopidogrel. The inhibition of platelets was assessed using light transmittance aggregometry. Plasma concentrations of clopidogrel as well as its active (clopi-H4) and inactive (CLPM) metabolites were measured using HPLC-MS-MS method. Among 21 genes, the carriers of CYP2C19*2 were associated with lower exposure to its active (clopi-H4) and inactive (CLPM) metabolites (both P<0.05 vs. non-carriers) and thus decreased platelet inhibition (P<0.05 vs. non-carriers). Notably, the carriers of ABCB1 C3435T were associated with lower levels of plasma clopidogrel and its active (clopi-H4) and inactive (CLPM) metabolites (all P<0.05 vs. non-carriers) which also correlated with subsequently decreased platelet inhibition (P<0.05 vs. non-carriers). There were no obvious effects of other studied genes on clopidogrel.

CONCLUSIONS

CYP2C19*2 is a determinant for the formation of the active metabolite of clopidogrel and its antiplatelet effects. Meanwhile, ABCB1 C3435T plays an important role in intestinal absorption of clopidogrel which further affects the exposure to the active metabolite of clopidogrel and platelet aggregation.