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The risk of ischaemic events including stent thrombosis varies with the efficacy of aspirin to inhibit platelet reactivity. This study sought to investigate whether homozygous GUCY1A3 (rs7692387) risk allele carriers display higher on-aspirin platelet reactivity and risk of ischaemic events early after coronary intervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and results<\/jats:title><jats:p>The association of GUCY1A3 genotype and on-aspirin platelet reactivity was analysed in the genetics substudy of the ISAR-ASPI registry (n\u2009=\u20091678) using impedance aggregometry. The clinical outcome cardiovascular death or stent thrombosis within 30\u2009days after stenting was investigated in a meta-analysis of substudies of the ISAR-ASPI registry, the PLATO trial (n\u2009=\u20093236), and the Utrecht Coronary Biobank (n\u2009=\u20091003) comprising a total 5917 patients. Homozygous GUCY1A3 risk allele carriers (GG) displayed increased on-aspirin platelet reactivity compared with non-risk allele (AA\/AG) carriers [150 (interquartile range 91\u2013209) vs. 134 (85\u2013194) AU\u22c5min, P\u2009&lt;\u20090.01]. More homozygous risk allele carriers, compared with non-risk allele carriers, were assigned to the high-risk group for ischaemic events (&gt;203\u2009AU\u22c5min; 29.5 vs. 24.2%, P\u2009=\u20090.02). Homozygous risk allele carriers were also at higher risk for cardiovascular death or stent thrombosis (hazard ratio 1.70, 95% confidence interval 1.08\u20132.68; P\u2009=\u20090.02). Bleeding risk was not altered.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We conclude that homozygous GUCY1A3 risk allele carriers are at increased risk of cardiovascular death or stent thrombosis within 30\u2009days after coronary stenting, likely due to higher on-aspirin platelet reactivity. Whether GUCY1A3 genotype helps to tailor antiplatelet treatment remains to be investigated.<\/jats:p><\/jats:sec>","DOI":"10.1093\/cvr\/cvz015","type":"journal-article","created":{"date-parts":[[2019,1,16]],"date-time":"2019-01-16T15:13:42Z","timestamp":1547651622000},"page":"1512-1518","source":"Crossref","is-referenced-by-count":23,"title":["Association of the coronary artery disease risk gene GUCY1A3 with ischaemic events after coronary intervention"],"prefix":"10.1093","volume":"115","author":[{"given":"Thorsten","family":"Kessler","sequence":"first","affiliation":[{"name":"Klinik f\u00fcr Herz- und Kreislauferkrankungen, Deutsches Herzzentrum M\u00fcnchen, Technische Universit\u00e4t M\u00fcnchen, Munich, Germany"},{"name":"Deutsches Zentrum f\u00fcr Herz-Kreislauf-Forschung (DZHK) e.V., Partner Site Munich Heart Alliance, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Wolf","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Herz- und Kreislauferkrankungen, Deutsches Herzzentrum M\u00fcnchen, Technische Universit\u00e4t M\u00fcnchen, Munich, Germany"},{"name":"Deutsches Zentrum f\u00fcr Herz-Kreislauf-Forschung (DZHK) e.V., Partner Site Munich Heart Alliance, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niclas","family":"Eriksson","sequence":"additional","affiliation":[{"name":"Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Kofink","sequence":"additional","affiliation":[{"name":"Division of Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, University of Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bakhtawar K","family":"Mahmoodi","sequence":"additional","affiliation":[{"name":"Cardiology Department, St. Antonius Hospital, Nieuwegein, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Himanshu","family":"Rai","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Herz- und Kreislauferkrankungen, Deutsches Herzzentrum M\u00fcnchen, Technische Universit\u00e4t M\u00fcnchen, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinicius","family":"Tragante","sequence":"additional","affiliation":[{"name":"Division of Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, University of Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"\u00c5kerblom","sequence":"additional","affiliation":[{"name":"Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden"},{"name":"Division of Cardiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard C","family":"Becker","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Health and Disease, University of Cincinnati Heart, Lung & Vascular Institute, Cincinnati, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabell","family":"Bernlochner","sequence":"additional","affiliation":[{"name":"I. 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