The relationship between on-clopidogrel platelet reactivity, genotype, and post-percutaneous coronary intervention outcomes in Chinese patients

Scand J Clin Lab Invest. 2015 May;75(3):223-9. doi: 10.3109/00365513.2014.993696. Epub 2015 Jan 16.


Background: High on-clopidogrel platelet reactivity reflects a poor response to clopidogrel and is associated with ischemic events, which has been attributed to several factors such as demographic, clinical characteristics and a polymorphism of CYP2C19. Some new platelet assays monitoring on-clopidogrel platelet reactivity are currently available in China, but their relevance to the CYP2C19 genotype and post-percutaneous coronary intervention outcomes remain to be elucidated.

Methods: Patients were prospectively included if they had a successful percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) and received clopidogrel and aspirin. CYP2C19 loss-of function genotype, adenosine diphosphate (ADP)-induced maximum platelet aggregation rate (MPA ADP) measured by light transmittance aggregometry, ADP-induced platelet-fibrin clot strength (MA ADP) measured by thrombelastography, platelet reactivity index (PRI) measured by vasodilator-stimulated phosphoprotein phosphorylation (VASP), and the occurrence of 6-month major adverse cardiovascular events (MACE) were assessed in 178 patients.

Results: High on-treatment platelet reactivity prevalence defined by MPA ADP > 46.0%, MA ADP > 47 mm and PRI > 50.0% was 27.0%, 24.2%, and 61.2%, respectively. ADP-specific assays (VASP PRI) differed according to CYP2C19 genotype, with a significant gene-dose effect (PMs > IMs > EMs, p < 0.05). Multivariate analysis showed MPA ADP > 46.0% and MA ADP > 47 mm to be independent predictors of MACE at 6 months.

Conclusions: CYP2C19 loss-of function genotypes with the *2 and/or *3 allele are highly prevalent in the Chinese population and are associated with higher residual platelet reactivity. High on-treatment platelet reactivity defined by MPA ADP or MA ADP predicts an increased risk of MACE for ACS patients undergoing PCI.

Keywords: Acute coronary syndrome; CYP2C19; clopidogrel; platelet function assay.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / blood
  • Acute Coronary Syndrome / drug therapy*
  • Acute Coronary Syndrome / genetics
  • Acute Coronary Syndrome / therapy
  • Aged
  • Blood Platelets / drug effects
  • Blood Platelets / physiology*
  • China
  • Clopidogrel
  • Combined Modality Therapy
  • Cytochrome P-450 CYP2C19 / genetics
  • Female
  • Genotype
  • Humans
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention
  • Platelet Aggregation Inhibitors / pharmacology*
  • Platelet Aggregation Inhibitors / therapeutic use
  • Ticlopidine / analogs & derivatives*
  • Ticlopidine / pharmacology
  • Ticlopidine / therapeutic use
  • Treatment Outcome


  • Platelet Aggregation Inhibitors
  • Clopidogrel
  • CYP2C19 protein, human
  • Cytochrome P-450 CYP2C19
  • Ticlopidine