Abstract 12690: Impact of CYP2C19 Polymorphism on In-Stent Restenosis in Patients With Drug-Eluting Stent Implantation
Background: Recent data suggest that cytochrome P450 (CYP) enzymes such as CYP2J and 2C are localized in vascular smooth muscle cell (SMC) and endothelium and may regulate the proliferation of SMC. Intimal hyperplasia, which is regarded as smooth muscle cell proliferation, is one of the mechanisms of in-stent restenosis (ISR). However, it is unknown whether polymorphism of CYP enzymes is associated with the ISR after drug-eluting stent (DES) implantation. The aim was to examine the impact of CYP2C19 genotype on ISR after DES implantation.
Methods: We examined CYP2C19 genotype and ISR in 113 pts with DES implantation. Moreover, platelet aggregation induced by adenosine diphosphate was measured in patients taking dual antiplatelet therapy such as aspirin and clopidogrel. The ISR was analyzed by quantitative coronary analysis (QCA) at a mean follow-up of 9 months.
Results: CYP2C19 genotypes were divided into 2 groups; (1) carriers with CYP2C19 loss-of-function allele *2 or *3 (n=78, male; 52, 69.5yrs); (2) non-carriers with CYP2C19 normal function allele *1 and without loss-of-function allele (n=35, male; 21, 67.5yrs). There were no significant differences in patients' characteristics between carriers and non-carriers. The frequency of ISR by binary criteria (>50%) was higher in carriers than in non-carriers, although not significantly (9 vs 3 cases, NS). The ratio of target lesion revascularization (TLR) was also higher in carriers than in non-carriers (6 vs 1, NS). Percent diameter stenosis showed significantly higher levels in carriers compared with non-carriers (32.2 vs 17.4 %, P<0.05). The levels of platelet aggregation were also significantly higher in carriers than non-carriers (4451+/-1460 vs 3155+/-1545 AU*min, P<0.05). Moreover, optimal coherence tomography (OCT) was performed in several cases (n=23). Intimal hyperplasia with thrombus by OCT was more frequently found in carriers compared with non-carriers.
Conclusion: In this study, the value of percent diameter stenosis differed according to CYP2C19 genotype. These results suggest that carriers of CYP2C19 *2 or *3 loss-of-function allele may be associated with the mechanism of intimal hyperplasia after DES implantation.
- © 2011 by American Heart Association, Inc.