Abstract 16393: Vascular Endothelial Function and Platelet Reactivity by Gender Differences Based on CYP2C19 Polymorphism are Associated With Cardiovascular Events Risk in Patients Undergoing Percutaneous Coronary Intervention (PCI)
Background: Vascular endothelial function and CYP2C19 polymorphism are associated with clinical outcomes following PCI. However, the relation of gender differences to vascular endothelial function based on CYP2C19 polymorphism has not been reported. The aim was to examine the impact of vascular endothelial function by gender differences on clinical outcomes between carrier and non-carrier of CYP2C19 loss-of-function (LOF) allele following stent implantation.
Methods: We enrolled 491 patients following stent implantation, taking dual antiplatelet therapy 100mg/day aspirin and 75mg/day clopidogrel, in this prospective study with 12 months follow-up. Patients were divided into Carrier (at least one LOF alleles (*1/*2, *1/*3*, 2/*2, *2/*3, *3/*3) carriage, n=324) and Non-carrier (normal function allele (CYP2C19*1/*1) carriage, n=167). Vascular endothelial function was evaluated by using reactive hyperemia peripheral arterial tonometry (RH-PAT), and platelet reactivity (PR) using light transmission aggregometer was measured as response to clopidogrel. Clinical endpoint was cardiovascular death, myocardial infarction, stroke, any urgent revascularization, and intraprocedural thrombotic events.
Results: There were no differences in value of RH-PAT and clinical outcomes between Carrier and Non-carrier and between male and female. In males, there was no difference in RH-PAT levels irrespective of with or without cardiovascular events in Carrier and Non-carrier, respectively. However, in females, RH-PAT value was reduced (i.e. decreased endothelial function) in patients with adverse clinical events compared with those without events in Non-carrier (1.57+/-0.41 vs. 1.89+/-0.60, P<0.05), although there were no differences in RH-PAT levels irrespective of with or without clinical events in Carrier. Multivariate analysis showed that RH-PAT was a predictor for adverse clinical outcome in females, not males. Moreover, platelet reactivity was higher in patients with cardiovascular events than those without events in females of Non-carrier (4087AU*min vs. 3325, P<0.05).
Conclusions: In female patients undergoing stent implantation, RH-PAT value and platelet reactivity may be associated with adverse clinical events.
- © 2013 by American Heart Association, Inc.