A14513 The impact of cigarette smoking on platelet response to clopidogrel in Chinese patients undergoing percutaneous coronary intervention

Abstract

Objectives: Clopidogrel, is widely used in patients undergoing percutaneous coronary intervention (PCI). As an inducer of CYP1A2, cigarette smoking may theoretically enhance the clinical efficacy of clopidogrel. The purpose of this study was to investigate effects of cigarette smoking habits on the platelet response to clopidogrel. Methods: A total of 713 patients undergoing PCI were enrolled from Beijing Shijingshan Hospital and assigned to the treatment with a daily dose of 75 mg of clopidogrel. The patients’ smoking habits were obtained from questionnaire surveys. ADP-induced platelet inhibition was measured by thrombelastography (TEG). Results: For current smokers, significant higher ADP-induced platelet inhibition rate was found compared with nonsmokers and previous smokers (75.92 ± 22.76% vs. 65.55 ± 23.85% vs. 69.16 ± 26.57%, P = 0.019). After dividing patients (excluding previous smokers) into three groups by daily cigarettes (0, < 20, > = 20 cigarettes/day), the incidence of high on-treatment platelet inhibition (HTPI) increased and the trend was significant (P < 0.0001). Similarly, after grouping patients (excluding previous smokers) according to the years of smoking (0, < 30, > = 30 years), with increase of the smoking years, the occurrence of HTPI became higher (P < 0.0001).In a multivariate logistic regression analysis, cigarette smoking was an independent influencing factor for HTPI (OR [95% CI] = 1.497 [1.114–2.013], P = 0.007). Conclusion: Current smoking could enhance ADP-induced platelet inhibition during clopidogrel therapy in Chinese patients undergoing PCI. The study also demonstrated that smoking intensity may affect the response to clopidogrel.