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Published on: September 5, 2016
Platelet glycoprotein IIIa polymorphisms and risk of coronary stent thrombosis
D H Walter1, V Schächinger, M Elsner
1Department of Internal Medicine IV, University of Frankfurt, Germany.
Insights
The PIA2 gene variant increases the risk of coronary stent thrombosis. This finding suggests personalized antiplatelet therapy may be beneficial for patients with this genetic marker.
Area of Science:
- Cardiovascular Medicine
- Genetics
- Thrombosis Research
Background:
- Coronary stents effectively treat coronary stenoses but carry a risk of stent thrombosis.
- Platelet aggregation is a critical factor in the development of stent thrombosis.
- The study investigates the association between a specific platelet glycoprotein IIIa gene polymorphism (PIA2) and coronary stent thrombosis risk.
Purpose of the Study:
- To determine if the PIA2 allele of the platelet glycoprotein IIIa gene is associated with an increased risk of coronary stent thrombosis.
- To identify genetic predictors of stent thrombosis in patients undergoing coronary stent insertion.
Main Methods:
- A prospective study followed 318 patients for 30 days post-coronary stent insertion.
- Polymerase chain reaction (PCR) and gel electrophoresis were used to identify PIA1 and PIA2 alleles.
- Logistic regression analysis calculated the odds ratio for stent occlusion, assessing the relative risk associated with the PIA2 allele.
Main Results:
- The PIA2 allele was present in 19.8% of patients; 80.2% were homozygous for PIA1.
- Stent-vessel occlusion occurred in 9.5% of patients with the PIA2 allele versus 1.9% of PIA1 homozygous patients.
- Multivariate analysis identified the PIA1/A2 genotype as the sole significant independent predictor of stent thrombosis (Odds Ratio 5.26).
Conclusions:
- Patients carrying the PIA2 allele face a significantly higher risk of coronary stent thrombosis.
- This genetic predisposition may guide the use of glycoprotein-IIb/IIIa inhibitors for antiplatelet therapy.
- Potential increased bleeding complications with glycoprotein-IIb/IIIa inhibitors should be considered.
Background:
Coronary stents are an effective treatment for selected coronary stenoses. However, thrombosis of the stented segment is a major adverse complication. Platelet aggregation has a key role in stent thrombosis. We investigated whether a polymorphism of platelet glycoprotein IIIa gene (PIA2) is associated with an increased risk of coronary stent thrombosis.
Methods:
318 consecutive patients were followed up for 30 days after coronary stent insertion. The primary endpoints were death, myocardial infarction, stent-vessel occlusion, and coronary artery bypass surgery. Gel electrophoresis of PCR products was used to identify the PIA1 and PIA2 alleles. The relative risk of stent occlusion was calculated from the odds ratio on logistic regression analysis.
Findings:
63 (19.8%) of patients had the PIA2 allele and 255 (80.2%) were homozygous for PIA1. Baseline clinical, angiographic, and procedural features did not differ between the groups with and without the PIA2 allele. Occlusion of the stent vessel occurred in five (1.9%) patients homozygous for PIA1 and six (9.5%) patients with PIA2 allele (odds ratio 5.26 [95% CI 1.55-17.85]). On multivariate regression analysis PIA1/A2 genotype was the only significant independent predictor of stent thrombosis.
Interpretation:
Patients with the pIA2 allele have an increased risk of coronary stent thrombosis, which may warrant antiplatelet therapy with glycoprotein-IIb/IIIa inhibitors, although bleeding complications may also increase.
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