Bedside Genetic or Pharmacodynamic Testing to Prevent Periprocedural Myonecrosis During PCI (ONSIDE TEST)

Optimal P2Y12-receptor treatmeNt Guided by bedSIDe Genetic or Pharmacodynamic TESTing to Prevent Periprocedural Myonecrosis During Elective Percutaneous Coronary Intervention.

Patients undergoing percutaneous coronary intervention with a residual high platelet reactivity despite oral clopidogrel are at increased risk of ischaemic complications. The strategies to overcome the issue consist of switch to a more potent antiplatelet medications including prasugrel or ticagrelor. Economic constrains of many countries still do not allow wide reimbursement of newer antiplatelet agents. Therefore a strategy to personalise treatment according to genotype and phenotype characteristics of the patient may provide an attractive solution combining high clinical efficacy with low budget impact.

Inclusion Criteria:

• age 18-75
• elective PCI

Exclusion Criteria:

• acute coronary syndrome (troponin > 1 x ULN),
• administration of glycoprotein IIb/IIIa inhibitors,
• chronic total occlusion,
• lesions with extensive calcifications requiring rotational atherectomy,
• platelet count <70 000 /µl
• high bleeding risk,
• coronary bypass surgery in the previous 3 months,
• severe chronic renal failure (eGFR < 30 mL/min)
• requirement for warfarin, dabigatran, apixaban, rivaroxaban
• history of stroke or TIA,
• weight < 60 kg
• known bleeding diathesis,
• hematocrit of < 30% or >52%
• pregnancy