Clinical, Genetic Factors Linked to Early Stent Thrombosis

Independent association for three genes, two clopidogrel-related factors, clinical factors

TUESDAY, Oct. 25 (HealthDay News) -- Both genetic and clinical factors are independently associated with early stent thrombosis, according to a study published in the Oct. 26 issue of the Journal of the American Medical Association.

Guillaume Cayla, M.D., Ph.D., from the Pitié-Salpêtrière Hospital in Paris, and colleagues investigated the clinical and genetic factors associated with early stent thrombosis. A total of 123 patients with definite early stent thrombosis, and available DNA samples undergoing percutaneous coronary intervention (PCI) between January 2007 and May 2010 were compared with 246 age- and gender-matched stent thrombosis-free controls. The accuracy of early stent thrombosis prediction was measured in 23 genetic variants of 15 different genes.

The investigators found CYP2C19 metabolic status, ABCB1 3435 TT genotype, and ITGB3 PLA2 carriage to be significant determinants of early stent thrombosis. The acuteness of PCI, complex lesions, less than 40 percent left ventricular function, diabetes mellitus, use of proton pump inhibitors, and higher clopidogrel loading doses were identified as nongenetic, independent correlates of early stent thrombosis. Similar discriminative accuracy was seen for both the clinical-only and genetic-only models (P = 0.34). A significant increase in the discriminatory power was found for combined clinical and genetic model compared with the clinical-only model.

"This case-control study identified three genes (CYP2C19, ABCB1, and ITGB3) and two clopidogrel-related factors (loading dose and proton pump inhibitors) that were independently associated with early stent thrombosis," the authors write.

Several authors disclosed financial relationships with pharmaceutical companies, including Eli Lilly, which partially funded the study.

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