Impact of CYP2C19 Metabolizer Status on Patients With ACS Treated With Prasugrel Versus Clopidogrel
Jacob A. Doll, Megan L. Neely, Matthew T. Roe, Paul W. Armstrong, Harvey D. White, Dorairaj Prabhakaran, Kenneth J. Winters, Suman Duvvuru, Scott S. Sundseth, Joseph A. Jakubowski, Paul A. Gurbel, Deepak L. Bhatt, E. Magnus Ohman, Keith A.A. Fox and TRILOGY ACS Investigators
Impact of CYP2C19 Metabolizer Status on Medically Managed Patients With ACS
Hepatic conversion of clopidogrel and prasugrel prodrugs to their active metabolites with subsequent inhibition of platelet reactivity among (A) CYP2C19 extensive metabolizers (n = 3,870) or (B) CYP2C19 reduced metabolizers (n = 1,420). (C) Reduced metabolizer status was associated with higher on-treatment platelet reactivity among patients treated with clopidogrel but not with prasugrel. (D) Despite this, CYP2C19 metabolizer status was not associated with ischemic endpoints whether patients were treated with clopidogrel or prasugrel. ACS = acute coronary syndromes; CI = confidence interval; CV = cardiovascular; EM = extensive metabolizer; MI = myocardial infarction; RM = reduced metabolizer.