Characterization of patients with angioscopically-detected in-stent mural thrombi – genetics of clopidogrel responsiveness and generations of drug-eluting stents

Circulation Journal : Official Journal of the Japanese Circulation Society
Minoru IchikawaYoshiyuki Kijima

Abstract

The loss-of-function genotype of cytochrome P450 2C19 (CYP2C19) has been proposed as a risk factor for stent thrombosis in patients with drug-eluting stent implantation. The aim of this study was to clarify the clinical features of patients with angioscopically-detected in-stent mural thrombi (ISMT). Enrolled were 100 stented segments in 55 patients with stable angina (20 bare-metal stents; 39 Cypher sirolimus-eluting stents [SES]; 26 Endeavor zotarolimus-eluting stents [ZES]; 13 Xience V everolimus-eluting stents; and 2 Nobori biolimus-eluting stents). Dual antiplatelet therapy (100 mg aspirin+75 mg clopidogrel once daily) had been continued since stenting. A poor metabolizer (PM) of clopidogrel was defined as a homozygote of CYP2C19 loss-of-function alleles. Coronary angioscopy revealed ISMT in 6 patients (5 SES, 1 ZES). Between the ISMT group and control group (n=49), there were no significant differences with regards to the VerifyNow P2Y12platelet function assay or in-stent endothelial coverage grade. Exact logistic regression analyses with stepwise forward selection at a significance level of 0.10 were performed to reveal predictive variables for ISMT (respectively: odds ratio, 95% confidence interval, P value: CYP2C19 PM ...Continue Reading

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Citations

Jun 9, 2015·Circulation Journal : Official Journal of the Japanese Circulation Society·Takayuki IshiharaMasaaki Uematsu
Dec 9, 2014·Circulation Journal : Official Journal of the Japanese Circulation Society·Takao Shimohama, Junya Ako
Dec 31, 2016·Journal of cardiology·Yuji NishimotoYoshio Yasumura
Jan 23, 2016·Circulation Journal : Official Journal of the Japanese Circulation Society·Yuji NishimotoYoshio Yasumura
Nov 20, 2015·Circulation Journal : Official Journal of the Japanese Circulation Society·Dong-Yi ChenTien-Hsing Chen

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