October 25th, 2011

Genetic and Clinical Factors Linked to Stent Thrombosis

French researchers have identified several genetic and clinical factors independently tied to early stent thrombosis. Writing in the Journal of the American Medical Association, Guillaume Cayla and colleagues report on their case-control study comparing 123 patients with definite early stent thrombosis with 246 matched controls without stent thrombosis.

The researchers found three genes with variants that significantly and independently raised the risk for early stent thrombosis:

  • CYP2C19
  • ABCB1
  • ITGB3

Independent clinical factors were:

  • Acuteness of PCI
  • Complex lesions
  • LVEF <40%
  • Diabetes
  • Proton pump inhibitor use
  • Higher clopidogrel loading doses (inverse correlation)

The clinical and genetic models were about equal in their predictive power, but a combined model was significantly better than either alone.

Among the independent factors identified in the study, the researchers noted that the three genes and two of the clinical factors (loading dose and PPI use) were related to clopidogrel. They then called for future studies to determine “whether treatment adjustment on the basis of such global risk stratification can improve the prognosis of patients undergoing PCI.”

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