Jamilya Mansurova, Ludmila Karazhanova, Aisulu Zhunuspekova, Ainur Abylhairova
Department of Cardiology and Interventional Arrhythmology, Semey Medical University, Semey, Kazakhstan
Background
The consequence of insufficient suppression of increased activity of platelets can be a repeated cardiovascular event. At the heart of the variability of the pharmacological response of clopidogrel are many factors, among which the most important is the carrier of the CYP2C19*2 and -*3 polymorphisms associated with resistance to antiplatelet agents.
Aim
To study the prognostic value of CYP2C19 gene polymorphisms in the development of stent thrombosis in patients after myocardial revascularization.
Material and methods
The study included 47 patients with acute coronary syndrome (ACS) after myocardial revascularization (percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)), who took double anti-platelet therapy (DAPT): aspirin and clopidogrel. Pharmacogenetic testing to determine the allelic variants of CYP2C19*2, -*3 was carried out by the method of polymerase chain reaction (PCR). Statistical processing was performed using the SPSS program.
Results
A total of 47 patients were examined, with an average age of 57.1(+8.8) years. Male 34(72.3%) at the age of 55.7(+9.3) years, women 13(27.7%) at the age of 61(+6.4) years (p=0.037). In the history: 44(93.6%) patients had PCI, 3(6.4%) had CABG. Stents with a drug coating 38(80.9%), without drug coverage 6(12.8%). For recurrent coronary events: no event 20(42.6%), stent thrombosis 12(25.5%), stent restenosis 3(6.4%), incomplete revascularization 2(4.3), “no reflow” 2(4.3%), rhythm disturbance 1(2.1%), heart failure 2(4.3%), “clean vessels” 2(4.3%), failure of shunts 3(6.4%). Genetic testing was performed: normal genotype 29(61.7%), the CYP2C19*1/*2 heterozygote 13(27.7%), the CYP2C19*2/*2 homozygote 3(6.4%), the heterozygote CYP2C19*1/*3 2(4.3%). The odds ratio (OR) for carriers of CYP2C19*2 and -*3 for the development of repeated coronary events after myocardial revascularization is [OR 4.308; 95% CI; 1.139-16.296; p=0.031], stent thrombosis [OR 5.0; 95% CI, 1.225-20.409; p=0.025], stent thrombosis and shunt failure [OR 6.0; 95% CI; 1.573-22.889; p=0.009].
Conclusion
Carrying polymorphisms of the CYP2C19 *2, -*3 gene increases the risk of ischemic complications by 4-6 times, including stent thrombosis after myocardial revascularization.