title: Optimal aNtiplatelet pharmacotherapy guided by bedSIDE genetic or functional TESTing in elective PCI patients: A pilot study: ONSIDE TEST pilot.
abstract: BACKGROUND
  Dual antiplatelet therapy (DAPT) is recommended after elective percutaneous coronary intervention (PCI) in stable coronary artery disease (SCAD) patients; however, still one-third of patients do not obtain adequate platelet inhibition that may result in increased cardiovascular risk. The aim of the ONSIDE TEST study is to evaluate the clinical impact of point-of-care genotyping- and platelet function-based personalized dual antiplatelet strategies in SCAD individuals undergoing PCI.
  
  
  METHODS
  Fifty patients were randomized to one of the three study arms: 1) genotyping, 2) platelet function testing (PFT) and 3) control. Patients were tested with point-of-care Spartan RX CYP2C19 System (group 1) and VerifyNow P2Y12 assay (group 2). In cases of inadequate response to clopidogrel, a loading dose of prasugrel was administered before PCI. The main clinical endpoint is the incidence of periprocedural myocardial injury (PMI).
  
  
  RESULTS
  Five (32%) patients in the genotyping arm and two (13%) in the in the PFT arm were identi-fied as poor clopidogrel metabolizers. The periprocedural platelet reactivity was significantly lower in the genotyping (80 ± 49.0 PRU) and PFT (36.5 ± 47 PRU) arms as compared to the control arm (176 ± 67.8 PRU), p = 0.01 and p = 0.03, respectively. PMI appeared in 17 (37%) patients of the entire study population.
  
  
  CONCLUSIONS
  Personalized DAPT results in an improved platelet inhibition. Apart from genotyping and aggregometry, it is feasible to integrate into everyday clinical practice PMI rates which are relevant when comparing different strategies.
authors.affiliation: 1st Department of Cardiology, Medical University of Warsaw, Poland, Poland. lukasz@koltowski.com.
authors.forename: Lukasz
authors.initials: L
authors.lastname: Koltowski
authors.forename: Mariusz
authors.initials: M
authors.lastname: Tomaniak
authors.forename: Daniel
authors.initials: D
authors.lastname: Aradi
authors.forename: Zenon
authors.initials: Z
authors.lastname: Huczek
authors.forename: Krzysztof J
authors.initials: KJ
authors.lastname: Filipiak
authors.forename: Janusz
authors.initials: J
authors.lastname: Kochman
authors.forename: Pawel
authors.initials: P
authors.lastname: Balsam
authors.forename: Sylwia
authors.initials: S
authors.lastname: Gajda
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Opolski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000097:blood / Q000188:drug therapy* / Q000601:surgery; D065731:Cytochrome P-450 CYP2C19 / Q000378:metabolism*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D010865:Pilot Projects; D010974:Platelet Aggregation / Q000187:drug effects*; D010979:Platelet Function Tests; D019095:Point-of-Care Systems; D000068799:Prasugrel Hydrochloride / Q000008:administration & dosage* / Q000493:pharmacokinetics; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D055815:Young Adult
chemical_list: D000077144:Clopidogrel; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine
keywords: clopidogrel; pharmacotherapy individualization; platelet aggregation inhibitors; platelet testing; prasugrel