P5732Prasugrel or clopidogrel in non-ST-elevation acute coronary syndrome with CYP2C19 genetic variants undergoing percutaneous coronary intervention
Bibliographic record
Abstract
Background: CYP2C19 genetic variant (CYP2C19*2 or *3 loss-of-function allele) is linked with high-on-treatment platelet reactivity (HPR) during clopidogrel therapy. There is insufficient data offered any significant influence of LOF alleles on the platelet response to half-dose prasugrel in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS). Methods: In the PRAISE-GENE trial, 70 eligible patients with carriage of LOF alleles were screened by the Spartan RX CYP2C19 system (Spartan Bioscience Inc, Ottawa, Canada), randomized to receive either prasugrel (n=35, 30-mg load followed by 5 mg maintenance daily) or clopidogrel (n=35, 600-mg load followed by 75 mg maintenance daily). The pharmacokinetic response was assessed at post-loading status, post-24 hours and 30 days with VerifyNow method. Results: In comparison to clopidogrel, prasugrel achieved significantly lower P2Y12 reaction units [119 (56–175) vs. 245 (189–299)], [34 (8–58) vs. 196 (122–244)], and [134 (98–189) vs. 203 (144–248)] at each time-point measurement, respectively. For the primary endpoint, the HPR rate in prasugrel was lower than that in clopidogrel (2.9% vs. 25.7%, p=0.013) at post-loading 24 hours, (20.0% vs. 45.7%, p=0.041) at chronic post-30-day status as well. More than 60% of study population suffered from periprocedural myonecrosis based any post-procedure cTn elevation within 48 hours (65.7% for clopidogrel vs. 60.0% for prasugrel, p=0.805; relative risk: 0.91, 95% CI: 0.64–1.31, p=0.494). In regression analysis, neither VN-HPR at post-loading status before PCI nor prasugrel treatment was not associated with myonecrosis, interestingly, current smoking had a 44% reduction in this event (relative risk 0.56, 95% CI: 0.34–0.93, p=0.026). For safety endpoint, only 3 patients (4.3%) experienced minor bleedings (BARC: type 1), especially in prasurel group (8.6%), without occurrence of ischemic event during 30-day period.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".