P3704Open-labeled randomised controlled study of double dose clopidogrel versus ticagrelor in stable coronary artery disease (CAD) patients with clopidogrel resistance

Abstract

Results: Out of the 65,672 MIs recorded in patients age<80 years in SWEDE-HEART, in 2011-2015, 29,318 (44,6%) patients received tigarelor treatment. Implementation of ticagrelor varied significantly across county councils (figure). If all county councils had implemented ticagrelor to the same extend as the county council with the highest implementation an additional 11,681 (253, 5037, 2289, 2582 and 1520 per study year) patients would have been treated with ticagrelor. This would have resulted in 116 MIs and 116 cardiovascular deaths avoided, and additional 21 strokes occurring, during the 5 year study period. The long term health implications is a loss of 1371 years in full health. Conclusion:Over a 5-year period regional variation in ticagrelor implementation in MI patients age<80 years may have caused some 200 further cardiovascular events implying a loss of approximately 1350 years in full health, suggesting that implementation of new treatments should be given serious consideration. Further research to understand mechanisms of regional variation and their long-term consequences for health is warranted, and register data with good quality and coverage may have an important role to achieve this. P3702 | BEDSIDE Background and purpose:The variability in the clinical response to clopidogrel treatment has been attributed to genetic factors, but the specific genes and other risk factors remain unclear. We aimed at investigating the incidence and related risk factors of high on treatment platelet reactivity (HTPR) with clopidogrel therapy, primarily analysing the correlation between genetic polymorphisms and HTPR. Methods: 900 patients with coronary heart disease (CHD) undergoing PCI treatment were enrolled. They all received dual antiplatelet therapy with aspirin (300mg) plus clopidogrel (300mg) over 24h, or aspirin (100mg/day) and clopidogrel (75mg/day) over three days. Patients were divided into two groups according the result of ADP-inhibition rate (ADP-IR%). The single nucleotide polymorphism (SNP) were detected by MassArray genotyping system. The follow-up lasted at least 12 months and adverse endpoints events were recorded. Results: 1)Total incidence of HTPR was 15.74%, and the female's was significantly higher than male's (24.29% vs 13.01%, P<0.01). 2)Female (OR = 2.023, 95% CI: 1.146-3.571, P=0.015), diabetes mellitus (OR = 2.815, 95% CI: 1.737-4.561, P=0.000), Hcy (OR = 2.479, 95% CI: 1.092-5.629, P=0.030) and hs-CRP (OR = 8.476, 95% CI: 1.588-45.240, P=0.012) were positively correlated with the occurrence of HTPR.3)We found four positive SNPs polymorphism: rs1057910, rs2242480, rs2246709 and rs776746.4)The polymorphism of rs1057910 was positively correlated with HTPR (OR = 2.90, 95% CI: 1.44-5.68, P=0.003), while the polymorphism of rs2246709 (OR = 0.69, 95% CI: 0.49-0.98, P=0.039) and rs776746 (OR = 0.66, 95% CI: 0.45-0.97, P=0.034) were negatively correlated with HTPR. Female was positively correlated with rs1057910 mutation (OR = 3.24, 95% CI: 1.46-7.18, P=0.004), and negatively correlated with r...