Effect of Cytochrome P450 2C19 Polymorphism on Target Lesion Outcome After Drug-Eluting Stent Implantation in Japanese Patients Receiving Clopidogrel

被引：34

作者：

Nishio, Ryo ^{[1
]}

Shinke, Toshiro ^{[1
]}

Otake, Hiromasa ^{[1
]}

Sawada, Takahiro ^{[1
]}

Haraguchi, Yoko ^{[1
]}

Shinohara, Masakazu ^{[1
]}

Toh, Ryuji ^{[1
]}

Ishida, Tatsuro ^{[1
]}

Nakagawa, Masayuki ^{[1
]}

Nagoshi, Ryoji ^{[1
]}

Kozuki, Amane ^{[1
]}

Inoue, Takumi ^{[1
]}

Hariki, Hirotoshi ^{[1
]}

Osue, Tsuyoshi ^{[1
]}

Taniguchi, Yu ^{[1
]}

Iwasaki, Masamichi ^{[1
]}

Hiranuma, Noritoshi ^{[1
]}

Konishi, Akihide ^{[1
]}

Kinutani, Hiroto ^{[1
]}

Shite, Junya ^{[1
]}

Hirata, Ken-ichi ^{[1
]}

机构：

[1] Kobe Univ, Grad Sch Med, Div Cardiovasc Med, Dept Internal Med,Chuo Ku, Kobe, Hyogo 6500017, Japan

来源：

CIRCULATION JOURNAL | 2012年 / 76卷 / 10期

关键词：

CYP2C19; Intra-stent thrombi; Major adverse cardiac events; Optical coherence tomography; Target lesion revascularization; OPTICAL COHERENCE TOMOGRAPHY; PERCUTANEOUS CORONARY INTERVENTION; OF-FUNCTION POLYMORPHISM; 6-MONTH FOLLOW-UP; PLATELET REACTIVITY; TASK-FORCE; SIROLIMUS; CYP2C19; THROMBOSIS; CYP2C19-ASTERISK-2;

D O I：

10.1253/circj.CJ-12-0476

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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)

引用

页码：2348 / 2355

页数：8