Abdul Kader, Muhamad Ali S.K.

Bawadikji, Abdulkader Ahmad

Ibrahim, Baharudin

Sulaiman, Syed Azhar Syed

Yunus, Ahmad Zainuddin

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J O U R N A L O F T H E A M E R I C A N C O L L E G E O F C A R D I O L O G Y , V O L . 6 5 , N O . 1 7 , S U P P L S , 2 0 1 5 S11follow-up, the occurrence rate of the major cardiac adverse event
was similar between the patients with extensive metabolizers and
with poor and intermediate metabolizers (19 (9.5%) vs. 21 (8.4%),
p¼0.73). Survival analysis revealed similar MACE rates in patients
with poor and intermediate metabolizers with respect to extensive
metabolizers.
CONCLUSION Among Korean patients treated with clopidogrel for
PCI, carriage of even one reduced function CYP2C19 allele appears to
be associated signiﬁcantly with an increased level of PRU and a higher
incidence of High on-treatment clopidogrel platelet reactivity but
both the platelet reactivity and gene polymorphisms did not predict
major adverse cardiovascular events.TCTAP A-024
The Importance of Serial Measurement of Platelet Aggregation in Long
Term of Dual Antiplatelet Therapy in Drug Eluting Stent Era
Quan Li1
1Anzhen Hospital, China
BACKGROUND The dual antiplatelet therapy (DAPT) including aspirin
and clopidogrel is the standard therapy in percutaneous coronary
intervention (PCI).However, the divergent duration of DAPT and the
varying response of clopidogrel were two substantial concerns in the
era of PCI, especially with drug-eluting stents (DES) implantation.
Therefore, we combined them together to evaluate their effect on long
term inﬂuence on patients undergoing DES.
METHODS Patients with coronary artery disease treated exclusively
with Cypher sirolimus-eluting stents (SES) or Endeavor zotarolimus-
eluting stents (ZES) between September 2006 and June 2009 were
screened. Among them patients were eligible for participation in this
retrospective analysis if they had undergone PCI implantation since
enrollment and not had a major adverse cardiovascular event (death,
myocardial infarction, stroke, stent thrombosis or repeat revasculari-
zation) within the ﬁrst year since implantation. all patients were
routinely measured AA and ADP during the PCI procedure. And then
all of the procedures were performed using standard interventional
techniques. The interventional strategy and device utilization,
including DES type (SES or ZES), were left to the discretion of the
operators. The primary endpoint (MACCE) was a composite of all-
cause death, nonfatal myocardial infarction (MI), stent thrombosis,
unexpected repeat revascularization, and stroke.
RESULTS 1245 suitable patients were analyzed for our purpose. There
were 204, 419, 289, 333 patients in the A group (12 month DAPT & low
platelet aggregation), B group (>12 month DAPT & high platelet ag-
gregation), C group (12 month DAPT & high platelet aggregation), D
group (>12 month DAPT & low platelet aggregation), respectively.
Compared with the rest of patients, the D group was associated with
decreased incidence of MACCE [HR 0.485, 95%CI (0.25-0.96);
P¼0.038]; when cox proportional hazard models were further tested
with the D group as the reference category within the same group, the
B and C group were associated with more incidence of MACCE[HR
2.26, 95%CI (1.10-4.68); P¼0.0273] and [HR 2.31, 95%CI (1.03-
5.18);P¼0.0413]. Their respective multivariate Cox proportional
hazards regressions conﬁrmed the tendencies mentioned above. As
concerned to MACE, The univariate Cox proportional hazards
regression demonstrated the B group, overlapping stents, small ves-
sels, and PVD were also linked to more incidence of MACE. After
adjustment by multivariate Cox proportional hazards regression, PVD
was still an independent risk factor of the MACCE.
CONCLUSION This is the ﬁrst study that took into account the
duration of DAPT and serial measurement of individual platelet
function together in the routine clinical practice in the long term.
The present study demonstrated the lower mean ADP level could
guarantee a clinical beneﬁt in the long term not only in primary
endpoint but also in secondary endpoint. This relationship suggested
the mean of ADP could better reﬂect the response of clopidogrel and
underlined the importance of serial measurements of ADP in chronic
administration. Our study demonstrated serial measurement of ADP
level was of importance in long term use of DAPT; The present re-
sults demonstrated patients with extension of DAPT above a year
with lower ADP level could beneﬁt compared with the rest patients.
Further comparisons were made among the four groups, which
suggested the B and C groups were risk factors compared with the D
group. In other words, it supported the D group was superior to the
B and C groups.TCTAP A-025
Impact for Discontinuation of Dual Antiplatelet Therapy for Unexpected
Reason Within 3 Months After 2nd Drug Eluting Stent Implantation
Yohsuke Honda1
1Saiseikai Yokohama City Eastern Hospital, Japan
BACKGROUND To assess the safety of discontinuation of dual anti-
platelet therapy (DAPT) for unexpected reason within 3 months
after2nd drug-eluting-tent (2nd DES) implantation.
METHODS A total of 1661 consecutive patients(age 7010 years, male
74%)(2764 lesions) who underwent 2nd DES implantation was
enrolled. 150 patients (190 lesions) received DAPT within 3 months
(short group) and 1577 patients (2526 lesions) received DAPT above
3months (long group). 34 patients (48 lesions) who stopped both of
antiplatelet therapy excluded. The typical reasons to stop DAPT
within 3months were allergy, bleeding and no adherence. Primary
outcome was deﬁnite and probable stent thrombosis deﬁned by Aca-
demic Research Consortium (ARC).
RESULTS Patient and lesion characteristics were similar between two
groups except age which was higher in short group than long group
(7210 vs. 6910, p＜0.001). Mean DAPT duration was 3633 days in
short group and 698386 days in long group. Aspirin was mainly
selected as whole life single antiplatelet therapy in both groups (short
82.4% vs. long 81.7%, p¼0.82). In follow up term (24.713.4 months),
the incidence of ST was similar between two groups (1.0% in short
group vs. 0.5% in long group, p¼0.34).
CONCLUSION Discontinuation of DAPT for unexpected reason within
3 months after 2nd DES implantation did not increase the risk for ST.
TCTAP A-136
Identifying the Particular Human Plasma Metabolites Which Produces the
Best Response from Warfarin Based on International Normalized Ratio
Abdulkader Ahmad Bawadikji,1 Syed Azhar Syed Sulaiman,1
Ahmad Zainuddin Yunus,1 Muhamad Ali S.K. Abdul Kader,2
Baharudin Ibrahim1
1Universiti Sains Malaysia, Malaysia; 2Penang General Hospital, Penang
Island, Malaysia
BACKGROUND Warfarin, an anticoagulant drug has been used regu-
larly despite of its bleeding tendency. This adverse effect is usually
controlled by checking International Normalized Ratio (INR). The aim
of this study is to determine the ability of plasma metabolites to
distinguish individuals with different INR stability.
METHODS This study focuses on two types of patients; stable INR
(2-3) and unstable INR (<2 or >3), 44 patients of stable group, and 50
patients of unstable group, on at least 9-month warfarin treatment.
Both groups were selected based on Morisky scale> 6 (medium to high
adherence). The INR was monitored for each individual during the last
six months of the treatment period. INR case without changes was
considered stable. Otherwise, it would be considered unstable. The
blood samples were centrifuged and the obtained plasma samples
were mixed with phosphate buffer (1:1). The mixture was centrifuged
and the supernatant was taken to perform 1H-NMR experiment. The
NMR spectra were binned and the data were analyzed using principle
component analysis (PCA) and orthogonal partial least squares
discriminant analysis (OPLS-DA).
RESULTS Fifteen female and 29 male patients (mean age 66.5),
treated with the average warfarin dose of 3.08 mg, showed a stable
INR while the unstable group including 28 males and 22 females
(mean age 64.7) was treated with the average dose of 3.66 mg. No
signiﬁcant difference was observed between two groups with respect
to warfarin dose (p¼ 0.066), the patient age (p¼ 0.415) and gender
(p¼ 0.332). Three outliers were identiﬁed in PCA score plot. The OPLS-
DA four-component model (96% accuracy, 97.73% sensitivity, and
96.81% speciﬁcity) with R2 (cum) ¼ 0.575 and Q2 (cum) ¼ 0.355
revealed a clear separation between the two groups. Through the VIP
plot, the discriminatory metabolites were determined.
CONCLUSION The plasma metabolomics technique able to differen-
tiate the plasma metabolic proﬁles of the patients on warfarin with
stable and unstable INR. Validations of the metabolites with more
subjects are ongoing.


TCTAP A-136 Identifying the Particular Human Plasma Metabolites Which Produces the Best Response from Warfarin Based on International Normalized Ratio 

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TCTAP A-136 Identifying the Particular Human Plasma Metabolites Which Produces the Best Response from Warfarin Based on International Normalized Ratio

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