Effect of Calcium Channel Blockers on Antiplatelet Activity of Clopidogrel in Patients Undergoing Percutaneous Coronary Intervention: Insights from the PTRG-DES Consortium

• Main Authors: HoungBeom Ahn MD (Author), Hyun-Wook Chu MD (Author), Ae-Young Her MD, PhD (Author), Young-Hoon Jeong MD, PhD (Author), Byeong-Keuk Kim MD, PhD (Author), Hyung Joon Joo MD, PhD (Author), Kiyuk Chang MD, PhD (Author), Yongwhi Park MD, PhD (Author), Sung Gyun Ahn MD, PhD (Author), Sang Yeup Lee MD, PhD (Author), Jung Rae Cho MD, PhD (Author), Hyo-Soo Kim MD, PhD (Author), Moo Hyun Kim MD, PhD (Author), Do-Sun Lim MD, PhD (Author), Eun-Seok Shin MD, PhD (Author), Jung-Won Suh MD, PhD (Author)
• Format: Book
• Published: SAGE Publishing, 2024-11-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 1940-4034; 10.1177/10742484241298150
• Keywords: Diseases of the circulatory (Cardiovascular) system; RC666-701; Therapeutics. Pharmacology; RM1-950
• Source: Journal of Cardiovascular Pharmacology and Therapeutics, Vol 29 (2024)

Aims: Calcium channel blockers (CCBs) are frequently co-administered with clopidogrel in cardiovascular disease. Although an inhibitory drug interaction exists between them, comprehensive large-scale studies for its validation are lacking. We investigated interactions between CCBs and clopidogrel using a large-scale national registry of patients who underwent percutaneous coronary intervention (PCI). Methods and Results: The Platelet function and genoType-Related long-term Prognosis-Platelet Function Test consortium investigates the association between platelet function test and long-term prognosis during dual antiplatelet therapy including clopidogrel in patients using drug-eluting stents. We compared the ex vivo platelet reactivity using the VerifyNow P2Y12 test and clinical outcomes between CCB users and non-users. Between 2003 and 2018, 11 714 patients were enrolled and categorized into two groups according to CCB usage. A composite endpoint encompassing all-cause mortality, myocardial infarction, stent thrombosis, or stroke was defined as a major adverse cardiac and cerebrovascular event (MACCE). During the 5-year follow-up period, no significant differences were observed in P2Y12 reaction units (215.8 ± 84.7 vs 218.4 ± 76.7, P = .156), MACCEs, major bleeding, or high platelet reactivity rates, even after adjusting for propensity score matching (PSM) and inverse probability of treatment weighting (IPTW). When limited to the high platelet reactivity cohort (≥252 PRU), the results remained consistent for MACCE [PSM-adjusted, HR: 0.923 (0.644-1.323), P -value .663; IPTW-adjusted, HR: 1.300 (0.822-2.056), P -value .262]. Conclusions: CCB and clopidogrel co-administration does not appear to significantly impact clopidogrel responsiveness or clinical outcomes. Despite these promising results, further investigation may be warranted. Clinical trial registration: Platelet Function and genoType-Related Long-term progGosis in DES-treated Patients: A Consortium From Multi-centered Registries [PTRG-DES]; NCT04734028