Relationship between plasma concentration of clopidogrel and difference of individual response in patients with acute coronary syndrome

Objective To study the relationship between plasma concentration of clopidogrel and difference of individual response or major adverse cardiovascular events(MACE) in patients with acute coronary syndrome(ACS) after PCI. Methods The patients(n=200) diagnosed as CHD and having selected PCI were chosen and divided into high-reaction clopidogrel group(ADP inhibitory rate80%, n=105) and low-reaction clopidogrel group(ADP inhibitory rate80%, n=95) according to the outcomes of thrombelastogram(TEG). The plasma concentration of clopidogrel, 2-oxo-clopidogrel and carboxylic acid metabolites were detected by using high-throughput liquid chromatography-mass spectrometric(HTLC-MS/MS). The incidence of MACE was followed up after PCI for one year. Results The plasma concentration of clopidogrel was significantly lower, and that of carboxylic acid metabolites was slightly higher in low-reaction clopidogrel group than those in high-reaction clopidogrel group(all P0.05). The difference in plasma concentration of 2-oxo-clopidogrel had no statistical significance between two groups(P0.05). The incidences of relapsed angina and bleeding events were higher in low-reaction clopidogrel group than those in high-reaction clopidogrel group(P0.05). Conclusion The plasma concentration of clopidogrel effects on individual response, and low reaction to clopidogrel will increase the risk of MACE in clinic.