Abstract 14154: Intra-Stent Thrombus Early After Stent Implantation is Associated With Cytochrome P450 2C19 Genotypes in Clopidogrel-Treated Patients
Background: Cytochrome P450 (CYP) 2C19 polymorphism is associated with poor responsiveness to clopidogrel. This study aimed to clarify the relationship between CYP2C19 polymorphism and the incidence of intra-stent thrombus at early phase after drug-eluting stent (DES) implantation in patients treated with dual antiplatelet therapy (DAPT) with aspirin and clopidogrel.
Methods: We analyzed optical coherence tomography (OCT) imaging from 53 DESs of 25 patients both immediately after and early (33.5+/-18.8 days) after percutaneous coronary intervention. Implanted stents were second or third generation DES. All patients were treated with DAPT with aspirin and clopidogrel. Based on the CYP2C19 genotypes, patients were classified into three phenotype groups; extensive metabolizers (EMs), intermediate metabolizers (IMs) or poor metabolizers (PMs). We evaluated the relationship between the percentage of intra-stent thrombus and CYP2C19 phenotypes.
Results: The numbers of patients and stents implanted in each EMs, IMs and PMs group were 8/19, 13/23 and 4/11, respectively. The patient characteristics, rate of acute coronary syndrome (ACS), implanted stent and procedural characteristics were not significantly different among these groups. Immediately after stent implantation, percentage of intra-stent thrombus positive stent was not significantly different among 3 groups (EMs/IMs/PMs: 42.1%/47.8%/63.6%). However, owing to the fact that rate of thrombus disappearance was significantly higher in order EMs 75.0%, IMs 33.3% and PMs 14.3% (p=0.045), percentage of intra-stent thrombus positive stent at the time of early phase follow-up progressively and significantly increased in order EMs 10.5%, IMs 34.8%, PMs 54.5% (p=0.033).
Conclusions: Due to the poor disappearance of the intra-stent thrombus formed at the time of stent implantation, intra-stent thrombus at early follow-up period is more frequent in Cytochrome P450 2C19 poor/intermediate metabolizers.
Author Disclosures: M. Toyama: None. Y. Kuroda: None. E. Ojima: None. Y. Oishi: None. S. Maruta: None. S. Watanabe: None.
- © 2016 by American Heart Association, Inc.