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SummaryPrasugrel, a novel P2Y12 receptor inhibitor, is administered to patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI), but it can increase the risk of bleeding. The Japanese exhibit weaker responses to clopidogrel than other races because of CYP2C19 polymorphisms; thus, it is unclear whether these patients should continue dual antiplatelet therapy (DAPT) using prasugrel or switch to clopidogrel in the chronic phase. Here we evaluated the clinical outcomes of DAPT guided by CYP2C19 polymorphisms after implantation of second-generation drug-eluting stents (DESs) for ACS management. Patients with ACS receiving PCI via DES from November 2011 to March 2015 were divided into two groups: conventional DAPT with clopidogrel (n = 41) and gene-guided DAPT (n = 24). In the gene-guided DAPT group, all patients with ACS were given DAPT using prasugrel as soon as possible; extensive and intermediate metabolizers receiving PCI for the first time were switched to clopidogrel at least 2 weeks after discharge, and intermediate metabolizers with repeated ACS and poor metabolizers continued on DAPT using prasugrel. Notably, geneguided DAPT significantly reduced major adverse cardiovascular/cerebrovascular events (MACCEs; 22.0% versus 4.2%, hazard ratio [HR]: 0.15, 95% confidence interval [CI]: 0.01-0.81; P = 0.0247). Hemorrhagic complications were observed in 3.1% of patients receiving conventional DAPT and absent in the gene-guided group. Moreover, multivariate analysis showed that gene-guided DAPT significantly decreased MACCE incidence (HR: 0.15, 95% CI: 0.01-0.81; P = 0.033). Collectively, these data suggest that CYP2C19 polymorphism analysis may improve treatment decisions in patients with ACS receiving DES-PCI.(Int Heart J 2018; 59: 21-26) Key words: Prasugrel, Clopidogrel, Percutaneous coronary intervention (PCI), Major adverse cardiovascular/ cerebrovascular event (MACCE) P ercutaneous coronary intervention (PCI) is the first-line therapy for acute coronary syndrome (ACS), and drug-eluting stents (DESs) have been widely employed with excellent results in patients with stable coronary artery disease (CAD) or ACS.1,2) However, Japanese individuals exhibit weaker responses to clopidogrel, a classic P2Y12 receptor inhibitor, owing to an increased incidence of CYP2C19 loss-of-function polymorphisms.3) Recent reports have established the efficacy of prasugrel, a novel P2Y12 receptor inhibitor exhibiting strong inhibition of platelet aggregation, in patients with ACS after PCI independent of CYP2C19 function.4) However, prasugrel may increase the risk of bleeding, 5) and it is unknown whether patients with ACS should continue dual antiplatelet therapy (DAPT) using prasugrel or be switched to DAPT using clopidogrel during the chronic phase.In this study, we evaluated 1-year clinical outcomes of patients receiving CYP2C19 polymorphism-guided DAPT after implantation of second-generation DESs for ACS management. Methods Study population:We evaluated consecutive patients with ACS who received ...

Background: The implantable cardioverter defibrillator (ICD) is a standard prevention therapy for patients at high risk for sudden cardiac death (SCD) due to life-threatening ventricular arrhythmia (VA), that is, ventricular fibrillation and ventricular tachycardia. However, clinical predictors of recurrent VA in secondary prevention ICD recipients with coronary artery disease (CAD) remain unknown. Methods and Results: We followed up 96 consecutive patients with CAD undergoing ICD implantation for secondary prevention of SCD. Long-term rates and clinical predictors of appropriate ICD therapy (ICD-Tx) for VA were analyzed. Appropriate ICD-Tx occurred in 41 (42.7%) patients during a median follow-up of 2.4 years (interquartile range, 0.9-6.1). These patients had significantly greater left ventricular end-diastolic diameter (62.3±1.

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