Genotyping Infarct Patients to Adjust and Normalize Thienopyridine Treatment

Study Overview
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Brief Summary
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The objective of GIANT Study is to evaluate the clinical impact of genetic resistance to thienopyridine profile determination (CYP2C19 gene) and the clinical impact of compliance to an adjusted thienopyridine treatment on STEMI patients treated by primary PCI within the 24 hours following the first chest pain.

Detailed Description
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All the STEMI patients treated by primary PCI (with stent implantation) within the 24 hours following the first chest pain can be included in the GIANT study. After the PCI, they'll receive DAT (Aspirin + Clopidogrel/Prasugrel). Patients will then be genotyped to determine if they carry one of the CYP2C19 gene variants making them resistant or hyper responder to clopidogrel. The genetic profile of the patients will be communicated to the physician who took care of them so that he can (or not) adjust the thienopyridine treatment (increase of the clopidogrel dosage, switch to prasugrel or switch to clopidogrel). A treatment will be prescribed for 12 months as according to the European guidelines. One year after the PCI, the patients will have to be available for a follow up visit. They'll be submitted to a VERIFY NOW P2Y12 protocol to determine whether they were compliant to their thienopyridine treatment. A clinical follow up will be also performed to evaluate the cardiovascular events.

Official Title
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Genotyping Infarct Patients to Adjust and Normalize Thienopyridine Treatment

Conditions
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Coronary Artery Disease, Acute Coronary Syndrome, Genetic Resistance to Clopidogrel, Compliance to Thienopyridine Treatment

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: STEMI patient treated within the first 24 hours with primary PCI (with stent implantation) Age superior or equal to 18 years old Informed consent signed Patient volunteer to be submitted to the 1 year visit follow up and to the clinical exams during this visit Patient benefiting from French social health system Exclusion Criteria: NONSTEMI patient with high troponin STEMI patient treated after the first 24 hours Stable / unstable angina or silent ischemia Cardiogenic shock Oral anticoagulation (Vitamin K Antagonists) Contraindication for PCI Age inferior to 18 years old Life expectancy inferior to 1 year Participation in another clinical trial No signed informed consent Patient not available for the 1 year visit follow up Pregnant women Known allergy to media contrast that can not be controlled by an adapted treatment Known allergy to cobalt chromium alloy Left ventricular ejection fraction lower than 30%

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| [*1] Genotype - Good responders to Clopidogrel<br>This group of patients is defined thanks to the DNA extracted from their saliva: [*1] genotype patients are good responders to clopidogrel | |
| [*2] genotype with adapted thienopyridine treatment<br>This group of patients is defined thanks to the DNA extracted from their saliva: [*2] genotype patients are bad responders to clopidogrel and their thienopyridine treatment has been adapted | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| statistical difference in Death, MI and stent thrombosis between genetically resistant patients (*2 genotype) with adapted treatment and non resistant patients (*1 genotype) |  | 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Difference in MACCE between responder + compliant patients vs responders + non compliant patients vs non responder patients. |  | 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Percutaneous coronary intervention, Acute coronary syndrome, Dual antiplatelet therapy, clopidogrel/prasugrel, genotyping, stent, compliance