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Effect of cytochrome P450 2C19 polymorphism on target lesion outcome after drug-eluting stent implantation in japanese patients receiving clopidogrel.
- Source :
-
Circulation journal : official journal of the Japanese Circulation Society [Circ J] 2012; Vol. 76 (10), pp. 2348-55. Date of Electronic Publication: 2012 Jul 03. - Publication Year :
- 2012
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Abstract
- Background: Cytochrome P450 (CYP) 2C19 polymorphism is associated with reduced responsiveness to clopidogrel and poor clinical outcome after drug-eluting stent (DES) implantation, but its contribution to lesion outcome after DES implantation is unclear.<br />Methods and Results: The study included 160 Japanese patients who received clopidogrel and underwent DES implantation with follow-up angiography. Patients were divided into 3 groups by CYP2C19 polymorphism: extensive metabolizers (EM), intermediate metabolizers (IM), and poor metabolizers (PM). The incidence of major adverse cardiac events (MACE) and target lesion revascularization (TLR) were compared among the 3 groups. Optical coherence tomography (OCT) was performed for 120 patients to evaluate the incidence of intra-stent thrombi. Of the 160 patients, the proportion of EM, IM, and PM was 37.5%, 48.1%, and 14.4%, respectively. The incidence of TLR and MACE was more frequent in IM and PM than EM (TLR: 18.2% and 26.1% vs. 3.3%, P=0.008, MACE: 22.1% and 30.4% vs. 5.0%, P=0.005). Among the 120 patients who underwent follow-up OCT, intra-stent thrombi were more frequently detected in IM and PM than in EM (45.6% and 63.2% vs. 20.5%, P=0.005). The incidence of TLR was significantly higher in patients with than in those without intra-stent thrombi (27.7% vs. 6.8%, P=0.003).<br />Conclusions: CYP2C19 loss-of-function polymorphism might be associated with the incidence of MACE and TLR in association with intra-stent thrombi.
- Subjects :
- Aged
Aged, 80 and over
Aryl Hydrocarbon Hydroxylases metabolism
Asian People
Clopidogrel
Coronary Angiography methods
Cytochrome P-450 CYP2C19
Female
Follow-Up Studies
Humans
Japan
Male
Middle Aged
Platelet Aggregation Inhibitors pharmacokinetics
Ticlopidine administration & dosage
Ticlopidine pharmacokinetics
Aryl Hydrocarbon Hydroxylases genetics
Drug-Eluting Stents
Platelet Aggregation Inhibitors administration & dosage
Polymorphism, Genetic
Thrombosis drug therapy
Thrombosis enzymology
Thrombosis genetics
Thrombosis pathology
Ticlopidine analogs & derivatives
Subjects
Details
- Language :
- English
- ISSN :
- 1347-4820
- Volume :
- 76
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Circulation journal : official journal of the Japanese Circulation Society
- Publication Type :
- Academic Journal
- Accession number :
- 22785462
- Full Text :
- https://doi.org/10.1253/circj.cj-12-0476