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Mayo Leads PGx Study for Antiplatelet Medication, Genotype Testing

NEW YORK (GenomeWeb News) – Mayo Clinic is partnering with three US healthcare groups to study if prescribing heart medications based on a patient's genotype will improve outcomes in angioplasty patients, NorthShore University HealthSystem, one of the project partners, said today.

The Tailored Antiplatelet Therapy to Lessen Outcomes After Percutaneous Coronary Intervention (TAILOR-PCI) study seeks to find out if testing for a patient's genotype will help prevent heart attack, stroke, unstable angina, and cardiovascular death in patients who undergo angioplasty.

The project involves Mayo Clinic's operations in Minnesota, Arizona, Florida, and Wisconsin, along with Lenox Hill Hospital in New York and NCH Healthcare System in Naples, Fla., and NorthShore, which is based in Evanston, Ill.

The antiplatelet medication clopidogrel bisulfate (Plavix) lowers the risk of negative outcomes by reducing the risk of blood clots around the surgical site, but Plavix remains ineffective until the liver enzyme CYP2C19 metabolizes the drug into its active form. Some alternative medications do not require activation through the same genetic pathway.

"What we're trying to do with TAILOR-PCI is to individualize the better antiplatelet therapy for patients with coronary stents based on their genotype," Jorge Saucedo, division head of cardiology at NorthShore, said in a statement.

"The current standard of care after angioplasty is to prescribe clopidogrel for one year, regardless of a person's individual genotype, even though we have known for several years that variation in the CYP2C19 gene may diminish the benefit from the drug," added Mayo Clinic's Naveen Pereira, PI on the project. "What we don't know – and why there is such confusion in the cardiovascular community – is how these genetic changes affect long-term clinical outcomes and whether we can decrease overall healthcare costs."

The three-year study, which is being run by Mayo's Center for Individualized Medicine, will involve 5,300 participants, and the partners will create a coronary artery disease DNA biobank.

Investigators at NorthShore and other sites plan to study these samples and use genome sequencing tools to analyze the origins of and risk factors for coronary heart disease.