Feature | November 04, 2013

Genetic Profiling May Provide Clinical Benefit by Identifying Heart Attack Patients Resistant to Blood Thinners

Results of the GIANT Trial Reported at TCT 2013

cath lab cardiac diagnostics genetic testing antiplatelet therapy blood monitors
November 4, 2013 — According to a new study, genetic profiling of patients undergoing percutaneous coronary intervention (PCI) may help cardiology teams adjust treatment and improve ischemic outcomes for patients who do not properly metabolize thienopyridine blood thinning therapies such as clopidogrel.
 
Findings from the GIANT trial were presented at the 25th annual Transcatheter Cardiovascular Therapeutics scientific symposium (TCT 2013).
 
The GIANT trial evaluated the clinical impact of CYP2C19 genetic profiling and compliance to an adjusted thienopyridine treatment. The primary endpoint was a composite of death, myocardial infarction and stent thrombosis after one year in slow responder patients with appropriate therapy after genotyping, compared to non-slow responders. 
 
The prospective, multicenter, single-arm study enrolled 1,499 patients at the time of primary PCI (onset chest pain < 24 hours). Genetic profiling was performed within 48 hours after intervention to detect a loss of CYP2C19 gene function and identify a resistance to clopidogrel. Strong recommendations for treatment adjustment were sent to investigators when patients were identified as slow responders. 
 
Dual antiplatelet therapy (DAPT) was prescribed for 12 months after PCI and one-year follow up was performed in 96.4 percent of patients (n = 1,445) including objective assessment of compliance. A total of 22 percent of patients (n = 319) had a profile associated with a CYP2C19 loss of function, known as the slow responder group. The remaining patients constituted the control group.
 
In the slow responder group, 85 percent received an adjusted thienopyridine regimen after the release of the genetic profile. Within the slow responder group, the patients who received adjusted therapy experienced fewer adverse events compared to those who did not receive adjusted therapy (3.3 percent versus 15.6 percent, respectively) after one year. Further, the patients who received adjusted therapy experienced a similar rate of adverse events as the control group (3.3 percent versus 3.04 percent). Poor compliance to treatment was objectively identified in 4.9 percent of patients at one year, and those patients experienced numerically more ischemic events.
 
“Results from the GIANT trial suggest that in patients with acute myocardial infarction treated with primary PCI, identification of a slow response to clopidogrel with subsequent adjustment of treatment leads to similar one year major ischemic event rates to patients with a favorable genetic profile to clopidogrel response,” said Bernard Chevalier, M.D., L'Institut CardioVasculaire Paris-Sud in Massy, Francem and lead investigator of the trial. “These findings may help determine alternative treatment strategies for patients identified as CYP2C19 poor metabolizers.” 
 
The GIANT trial was funded by Biotronik. Chevalier reported receiving research grants/speaker fees or being a consultant for Abbott Vascular, Asahi, Astra Zeneca, AVI, Boston Scientific, Biotronik, Colibri, Cook, Cordis, Daichi-Sankyo, Eli-Lilly, Iroko, Medtronic and Terumo. He is also currently a minor shareholder and director of CERC, a clinical research organization.
 
For more information: www.crf.org

Related Content

FDA Clears Abbott's High Sensitivity Troponin-I Blood Test
Technology | Blood Testing | October 09, 2019
Abbott recently announced that its Architect Stat High Sensitivity Troponin-I blood test has received clearance from...
Rapid Diagnosis Protocol for Chest Pain Does Not Improve Outcomes
News | Blood Testing | September 18, 2019
Discharge of patients with suspected acute coronary syndromes under a 0- and 1-hour high-sensitivity cardiac troponin T...
Validation Studies Confirm High Accuracy of Novel HART AI-Driven Blood Tests
News | Blood Testing | March 19, 2019
Prevencio Inc. announced data confirming the high accuracy of its artificial intelligence (AI)-driven, multiple-protein...
CoaguChek XS PT Test Strips Recalled for Inaccurately Reporting High INR
News | Blood Testing | December 28, 2018
Terrific Care LLC. / Medex Supply Dist Inc. initiated a nationwide recall on Dec. 19 of Roche CoaguChek test strips, as...
Abbott Point-of-Care Blood Test Speeds Heart Attack Diagnosis
News | Blood Testing | October 26, 2018
For someone experiencing cardiac symptoms in the emergency room, every minute matters as physicians determine whether...
New Noninvasive Blood Glucose Test as Effective as Finger Prick

Image courtesy of University of Missouri School of Medicine

News | Blood Testing | October 24, 2018
For those living with diabetes, monitoring blood glucose accurately is necessary to prevent diabetes-related...
Abbott Receives CE Mark for High Sensitive Troponin-I Test
News | Blood Testing | October 16, 2018
October 16, 2018 — Abbott announced that its High Sensitive Troponin-I...
AI-Driven Blood Test Accurately Diagnoses Peripheral Artery Disease in Diabetic Patient
News | Blood Testing | September 04, 2018
Prevencio Inc. announced new data demonstrating its HART PAD test accurately diagnoses peripheral artery disease (PAD)...
More Sensitive Blood Test Diagnoses Heart Attacks Faster
News | Blood Testing | August 06, 2018
August 6, 2018 — A new test to assess a whether or not someone is having a...
Singulex cTnl Assay Can Identify Presence, Severity of CAD in Stable, Symptomatic Outpatients
News | Blood Testing | March 26, 2018
March 26, 2018 — Measurement of cardiac troponin in stable patients with chest pain using the ultra-sensitive Singule
Overlay Init