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Association of CYP2C19*2 polymorphism with clopidogrel response and 1-year major adverse cardiovascular events in a multiethnic population with drug-eluting stents

BACKGROUND Patients undergoing elective percutaneous coronary intervention (PCI) with drug-eluting stents (DES) who have impaired clopidogrel response, have a higher risk of subsequent major adverse cardiovascular events (MACE). AIM OF THE STUDY To establish the relationship between CYP2C19 genotype, clopidogrel responsiveness and 1-year MACE. MATERIALS & METHODS Aspirin/clopidogrel responses were assessed with Multiplate Analyzer and CYP2C19*2 allele by SpartanRx. RESULTS A total of 42.0% carried ≥1 CYP2C19*2 allele. Prevalences of aspirin and clopidogrel high on-treatment platelet reactivity (HPR; local cutoffs: 300 AU*min for aspirin and 600 AU*min for clopidogrel) were 11.5% and 19.8% respectively. In multivariate ana-lysis, clopidogrel HPR was found to be an independent predictor for 1-year MACE (adj HR: 3.48, p = 0.022 ). CONCLUSION Having clopidogrel HPR could be a potentially modifiable risk factor guided by phenotyping.

ST-Elevation Myocardial Infarction in Situs Inversus Dextrocardia: A Case Report

SummaryST-elevation myocardial infarction (STEMI) in situs inversus dextrocardia is a rare combination and poses many challenges in terms of diagnosis and management. These include the early detection of dextrocardia as well as the interpretation of the ECG. In addition, percutaneous coronary intervention could be challenging in the setting of dextrocardia because of diffi culty in cannulating the coronary arteries, selection of catheters, catheter manipulation, image acquisition and interpretation.