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Do CYP2C19 and ABCB1 gene polymorphisms and low CYP3A4 isoenzyme activity have an impact on stent implantation complications in acute coronary syndrome patients?

Authors Rytkin E, Mirzaev KB, Grishina EA, Smirnov VV, Ryzhikova KA, Sozaeva ZA, Giliarov MI, Andreev DA, Sychev DA

Received 5 June 2017

Accepted for publication 25 August 2017

Published 18 September 2017 Volume 2017:10 Pages 243—245


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Martin Bluth

Eric Rytkin,1 Karin B Mirzaev,1 Elena A Grishina,1 Valeriy V Smirnov,2 Kristina A Ryzhikova,1 Zhannet A Sozaeva,1 Michael Iu Giliarov,2 Denis A Andreev,2 Dmitriy A Sychev1

1Russian Medical Academy of Continuous Professional Education, 2I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Moscow, Russian Federation

Aim: The aim of this study was to determine the impact of CYP2C19 and ABCB1 gene polymorphisms and CYP3A4 isoenzyme activity on stent implantation complications among patients with an acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI).
Patients and methods: Seventy-six patients (median age 63, range 37–91 years) with an ACS who underwent PCI were screened for CYP2C19 and ABCB1 gene polymorphisms with real-time polymerase chain reaction: CYP2C19*2, CYP2C19*17, and ABCB1 3435. CYP3A4 isoenzyme activity was determined by urine cortisol and 6-beta-hydroxycortisol levels. Stent implantation complications such as stent thrombosis (n=2) and restenosis (n=1) were observed among drug-eluting stent recipients.
Results: Low mean 6-beta-hydroxycortisol/cortisol ratio is indicative of impaired CYP3A4 activity and was associated with higher risk of thrombosis (β coefficient=0.022, SE 0.009, p=0.021 in the linear regression model). The increase in the length of the implanted stent was associated with higher risk of restenosis (β coefficient=0.006, SE=0.002, p=0.001 in the linear regression model). The presence of the CYP2C19*2 polymorphism did not affect the incidence of stent thrombosis (β coefficient=−1.626, SE=1.449, p=0.262 in the logistic regression model), nor did the CYP2C19*17 (β coefficient=−0.907, SE=1.438, p=0.528 in the logistic regression model) and ABCB1 3435 polymorphisms (β coefficient=1.270, SE=1.442, p=0.378 in the logistic regression model).
Conclusion: We did not find evidence that the presence of CYP2C19*2, CYP2C19*17, and ABCB1 3435 polymorphisms may jeopardize the safety of stent implantation in patients with an ACS. Patients with low CYP3A4 isoenzyme activity may have increased risk of stent thrombosis.

Keywords: acute coronary syndrome, clopidogrel, complications, polymorphism, stents

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