Nav: Home

Mayo Clinic studying genomics of antiplatelet heart medication

July 28, 2016

ROCHESTER, Minn. -- Which antiplatelet medication is best after a coronary stent? The Tailored Antiplatelet Therapy to Lessen Outcomes After Percutaneous Coronary Intervention (TAILOR-PCI) Study examines whether prescribing heart medication based on a patient's CYP2C19 genotype will help prevent heart attack, stroke, unstable angina, and cardiovascular death in patients who undergo percutaneous coronary intervention (PCI), commonly called angioplasty.

TAILOR-PCI, which began in 2013 with study teams at 15 hospitals in the U.S., Canada and South Korea and plans to enroll 5,270 patients, just received an additional $7 million from the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH), to complete the study. Twenty nine medical centers are now participating with more to be added soon. The randomized comparison of Plavix (clopidogrel bisulfate) and Brilinta (ticagrelor) was launched by Mayo Clinic Center for Individualized Medicine and the Department of Cardiovascular Diseases at Mayo Clinic in collaboration with Peter Munk Cardiac Centre, University Health Network, Toronto, and Spartan Bioscience, Ottawa.

"The NHLBI grant is validation of the importance of the question that needs to be answered: Is pharmacogenomics useful in prescribing individualized anti-platelet therapy after PCI," says Naveen Pereira, M.D., Mayo Clinic cardiologist and principal investigator of TAILOR-PCI. "This study will tell us whether this gene plays an important role in determining response to anti-platelet therapy after coronary interventions."

Michael Farkouh, M.D., M.Sc., cardiologist, Peter Munk Cardiac Centre, University Health Network, and principal investigator, describes this large, simple trial as "a true multinational collaboration designed to best inform clinical practice."

Yves Rosenberg, M.D., the NHLBI program officer for the study, and chief of the Atherothrombosis and Coronary Artery Disease Branch, added, "NHLBI is happy to support this important study, which we hope will contribute to the evidence needed to start delivering precision medicine in clinical settings. This trial could have global impact by potentially changing treatment recommendations for millions of individuals with coronary artery disease needing antiplatelet treatment after a percutaneous coronary intervention."

The costly and potential life-or-death question lingers after most of the 600,000 angioplasties performed every year in the U.S. The current standard of care after angioplasty is to prescribe clopidogrel for one year.

"Today, we do this regardless of a person's individual genotype, even though we have known for several years that variation in the CYP2C19 gene may diminish the benefit from the drug," Dr. Pereira says. "What we don't know -- and why there is such confusion in the cardiovascular community -- is whether these genetic differences affect long-term clinical outcomes."

Antiplatelet medication reduces the risk of heart attack, unstable angina, stroke and cardiovascular death after stent placement by reducing the possibility of blood clots around the surgical site.

Clopidogrel, however, remains ineffective until the liver enzyme CYP2C19 metabolizes the drug into its active form. Some alternative medications, including ticagrelor, do not require activation through the same genetic pathway. Ticagrelor has its own risks, says Dr. Pereira, including serious or life-threatening bleeding. In addition, ticagrelor costs approximately six to eight times as much and must be taken twice a day, compared with clopidogrel.

"Answering this question is important for the most appropriate and best patient care, and it also will help physicians and patients use health care dollars most responsibly," says Chet Rihal, M.D., chair of cardiovascular services for Mayo Clinic and study chair.
-end-
About Mayo Clinic's Center for Individualized Medicine

The Center for Individualized Medicine discovers and integrates the latest in genomic, molecular and clinical sciences into personalized care for each Mayo Clinic patient. For more information, visit http://mayoresearch.mayo.edu/center-for-individualized-medicine/.

About Mayo Clinic

Mayo Clinic is a nonprofit organization committed to clinical practice, education and research, providing expert, whole-person care to everyone who needs healing. For more information, visit http://www.mayoclinic.org/about-mayo-clinic or http://newsnetwork.mayoclinic.org/.

Mayo Clinic

Related Heart Attack Articles:

Where you live could determine risk of heart attack, stroke or dying of heart disease
People living in parts of Ontario with better access to preventive health care had lower rates of cardiac events compared to residents of regions with less access, found a new study published in CMAJ (Canadian Medical Association Journal).
Activated T-cells drive post-heart attack heart failure
Chronic inflammation after a heart attack can promote heart failure and death.
ICU care for COPD, heart failure and heart attack may not be better
Does a stay in the intensive care unit give patients a better chance of surviving a chronic obstructive pulmonary disease (COPD) or heart failure flare-up or even a heart attack, compared with care in another type of hospital unit?
Heart attack treatment might be in your face
Researchers at the University of Cincinnati have received $2.4 million in federal funding to pursue research on a novel cell therapy that would repair heart damage using modified cells taken from the patient's own facial muscle.
Tissue engineering advance reduces heart failure in model of heart attack
Researchers have grown heart tissue by seeding a mix of human cells onto a 1-micron-resolution scaffold made with a 3-D printer.
Study shows functional effects of human stem cell delivery to heart muscle after heart attack
Researchers delivered human stem cells seeded in biological sutures to the damaged heart muscles of rats following induced acute myocardial infarction and assessed the effects on cardiac function one week later.
Younger heart attack survivors may face premature heart disease death
For patients age 50 and younger, the risk of premature death after a heart attack has dropped significantly, but their risk is still almost twice as high when compared to the general population, largely due to heart disease and other smoking-related diseases The risk of heart attack can be greatly reduced by quitting smoking, exercising and following a healthy diet.
After the heart attack: Injectable gels could prevent future heart failure (video)
During a heart attack, clots or narrowed arteries block blood flow, harming or killing cells in the heart.
Heart failure after first heart attack may increase cancer risk
People who develop heart failure after their first heart attack have a greater risk of developing cancer when compared to first-time heart attack survivors without heart failure, according to a study today in the Journal of the American College of Cardiology.
1 in 4 patients develop heart failure within 4 years of first heart attack
One in four patients develop heart failure within four years of a first heart attack, according to a study in nearly 25,000 patients presented today at Heart Failure 2016 and the 3rd World Congress on Acute Heart Failure by Dr.

Related Heart Attack Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Setbacks
Failure can feel lonely and final. But can we learn from failure, even reframe it, to feel more like a temporary setback? This hour, TED speakers on changing a crushing defeat into a stepping stone. Guests include entrepreneur Leticia Gasca, psychology professor Alison Ledgerwood, astronomer Phil Plait, former professional athlete Charly Haversat, and UPS training manager Jon Bowers.
Now Playing: Science for the People

#524 The Human Network
What does a network of humans look like and how does it work? How does information spread? How do decisions and opinions spread? What gets distorted as it moves through the network and why? This week we dig into the ins and outs of human networks with Matthew Jackson, Professor of Economics at Stanford University and author of the book "The Human Network: How Your Social Position Determines Your Power, Beliefs, and Behaviours".