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Genetic factors related to early stent thrombosis
Dual anti-platelet therapy reduces cardiovascular events after percutaneous coronary intervention (PCI) by more than 80%. However, stent thrombosis can occur in 0.5–4% of patients within the first year following PCI, with the majority occurring in the first month. Cayla et al performed a case–control study using a candidate gene approach—looking in particular at genetic variations previously associated with clopidogrel pharmacogenetics and arterial thrombosis—in order to determine their impact on early stent thrombosis, in addition to established clinical and angiographic factors.
The study was conducted across 10 centres in France over a 3-year period and involved 123 patients undergoing PCI who had definite early stent thrombosis and DNA samples available, matched for age and sex with 246 thrombosis-free controls. Twenty-three genetic variants were investigated in 15 different genes and three were found to be significant: CYP2C19 metabolic status (adjusted OR 1.99), ABCB1 3435 TT genotype (adjusted OR 2.16) and ITGB3 PLA2 carriage (adjusted OR 0.52). Other non-genetic independent correlates included acuteness of PCI (adjusted OR 3.05), complex lesions (American College of Cardiology/American Heart Association type C) (adjusted OR 2.33), left ventricular function <40% (adjusted OR 2.25), diabetes mellitus (adjusted OR 1.82), use of proton pump inhibitors (adjusted OR 2.19) and higher clopidogrel loading doses (adjusted OR 0.73). A combined clinical and genetic model …