Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Cardiovascular Intervention
Effect of Cytochrome P450 2C19 Polymorphism on Target Lesion Outcome After Drug-Eluting Stent Implantation in Japanese Patients Receiving Clopidogrel
Ryo Nishio, Toshiro Shinke, Hiromasa Otake, Takahiro Sawada, Yoko Haraguchi, Masakazu Shinohara, Ryuji Toh, Tatsuro Ishida, Masayuki Nakagawa, Ryoji Nagoshi, Amane Kozuki, Takumi Inoue, Hirotoshi Hariki, Tsuyoshi Osue, Yu Taniguchi, Masamichi Iwasaki, Noritoshi Hiranuma, Akihide Konishi, Hiroto Kinutani, Junya Shite, Ken-ichi Hirata
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Keywords: CYP2C19, Intra-stent thrombi, Major adverse cardiac events, Optical coherence tomography, Target lesion revascularization
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2012 Volume 76 Issue 10 Pages 2348-2355

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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. 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). Conclusions: CYP2C19 loss-of-function polymorphism might be associated with the incidence of MACE and TLR in association with intra-stent thrombi.  (Circ J 2012; 76: 2348–2355)

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© 2012 THE JAPANESE CIRCULATION SOCIETY
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