Prevalence and Level of Thienopyridine Resistance Seen in a Contemporary Percutaneous Coronary Intervention or Coronary Artery Bypass Graft Population

Study Overview
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Brief Summary
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The primary objective of this prospective clinical registry is to determine the prevalence and level of thienopyridine resistance seen in a population undergoing contemporary percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG).

Detailed Description
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This is a prospective cohort study of 1000 patients presenting to the Washington Hospital Center for percutaneous coronary intervention or coronary artery bypass surgery. The aim of this prospective clinical registry is to determine the prevalence and level of thienopyridine resistance seen in a population presenting for cardiac catheterization and undergoing percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG). Thienopyridine resistance will be measured by flow cytometry of the vasodilator-stimulated phosphoprotein (VASP) phosphorylation, and/or the VerifyNow P2Y12 assay, and/or the Chrono-Log Lumi-Aggregometer, and/or the PlaCor PRT 7000 platelet reactivity assay. A secondary objective of this study is to correlate a variety of genetic polymorphisms with levels of platelet reactivity.

Official Title
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Prevalence and Level of Thienopyridine Resistance Seen in a Contemporary PCI and CABG Population

Conditions
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Increased Drug Resistance

Intervention / Treatment
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* Other: Thienopyridine resistance testing
* Other: Aspirin resistance testing
* Other: Genetic polymorphism assessment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient >18 years old. PCI group only: Patient scheduled to undergo cardiac catheterization or underwent percutaneous coronary intervention (PCI), during hospital stay. CABG group only: Patient is scheduled to undergo, or has underwent, coronary artery bypass surgery with at least one saphenous vein graft. Treated with a loading dose of clopidogrel or prasugrel at least 6 hours prior to the blood draw, or on a maintenance dose of clopidogrel or prasugrel for a minimum of 5 days. Genetic testing subgroup only: Patient has undergone PCI (only), and has been treated with a thienopyridine as in 4. Exclusion Criteria: Known allergies to aspirin, clopidogrel, or prasugrel; Use of a glycoprotein (GP) IIb/IIIa within 8 hours of the blood draw; Patient known to be pregnant or lactating; Patient with known history of bleeding diathesis or currently active bleeding; Platelet count <100,000/mm the day of the blood draw; Hematocrit <25% the day of the blood draw; On warfarin therapy at the time of the blood draw; Known blood transfusion within the preceding 10 days of the blood draw; Patient who has received NSAID (not including ASA) within preceding 24 hours of the blood draw; Any significant medical condition which in the investigator's opinion may interfere with the patient's optimal participation in the study.

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

| Intervention/Treatment |
| --- |
|Other: Thienopyridine resistance testing|Thienopyridine resistance will be measured by flow cytometry of vasodilator-stimulated phosphoprotein (VASP) phosphorylation, and/or VerifyNow P2Y12 assay, and/or the Chrono-Log Lumi-Aggregometer, and/or the PlaCor PRT 7000 platelet reactivity assay.|
|Other: Aspirin resistance testing|Aspirin resistance will be measured by the VerifyNow aspirin resistance assay.|
|Other: Genetic polymorphism assessment|The presence of minor alleles in selected single nucleotide polymorphisms (SNPs) as measured by the Applied Biosystems Open Array system.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The prevalence and degree of thienopyridine resistance | Thienopyridine resistance will be assessed by: oThe VASP assay, which measures the platelet reactivity index; and/or oThe VerifyNow P2Y12 receptor inhibition assay, which measures P2Y12 reaction units (PRU); and/or oThe Chrono-Log Lumi-Aggregometer, which measures platelet aggregation (via optical density or electrical impedance) in response to ADP stimulation; and/or oThe PlaCor PRT 7000 platelet reactivity assay | Duration of hospital stay; average hospital stay of less than 48 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The prevalence of aspirin resistance | The prevalence and degree of aspirin resistance will be measured by the VerifyNow aspirin resistance assay. | Duration of hospital stay; average hospital stay of less than 48 hours | 
| Correlate levels of platelet reactivity with the presence of selected genetic polymorphisms | The presence of minor alleles in selected single nucleotide polymorphisms (SNPs) as measured by the Applied Biosystems Open Array system. | Duration of hospital stay; average hospital stay of less than 48 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Thienopyridine resistance, Aspirin resistance, Platelet reactivity