Abstract 907: MCP-1 polymorphism rather than platelet ADP receptor polymorphism is Associated with an Increased Risk of Drug Eluting Stent Thrombosis-Results from the Multicenter Korean Stent Thrombosis (KOST) Registry
Background Although many clinical predictors of stent thrombosis(ST) have been reported, little is known about the role of genetic factors in the occurrence of DES thrombosis. To address these issues, we analyzed 3 candidate genetic variations related to vascular inflammation and platelet aggregation from patients enrolled in the multicenter Korean Stent Thrombosis (KOST) registry and matching controls.
Method The KOST registry was a multicenter study of 10 major medical centers(>700 PCI patient/year) in Korea, where we collected data of consecutive ST patients who underwent DES implantation from May, 2003 through Dec, 2006. All information were sent to a core center and the clinical, angiographic and procedural characteristics of ST patients were compared with a control group of 3,599 patients who had at least 6 months of clinical follow-up. Threee polymorphisms involved in the platelet aggregation(P2Y12 -iT744C and P2Y1 A1622G) and inflammation(MCP-1 -A2578G) were analyzed in 71 ST and 244 matched control patients by real time PCR.
Results The initial diagnosis of acute myocardial infarction at index procedure was not different between the ST and control group patients but ST patients were more younger and had less hypertension and dyslipidemia than control group patients. ST patients had more type 1 bifurcation lesions. The stent length, diameter and number was not different between the two groups. In the investigation of 3 polymorphisms possibly involved in the thrombotic process, two gain of function genotypes of platelet ADP receptor was not associated with ST, P2Y12 -i744C allele(OR 0.67;95% CI, 0.29 –1.56;P=0.352) and P2Y1 1622G allele(OR 0.73; 95% CI, 0.36 –1.48;P=0.39) but the proinflammatory genotypes of MCP-1 -2578G/G allele was independently associated with risk of DES thrombosis(OR 5.84;95% CI, 1.69 –20.11;P=0.005) in multivariate regression analysis.
Conclusion The vascular proinflammatory MCP-1 -2578G/G allele rather than genotypes of platelet hyperfunction was an independent predictor of DES thrombosis in this cohort of Korean patients. Our findings suggest that genetic factors may be involved in the risk of DES thrombosis, and warrant further studies to confirm the role of genetic polymorphisms in a much large series of patients.