Lack of association between peri-procedural myocardial damage and CYP2C19 gene variant in elective percutaneous coronary intervention.

Abstract

Peri-procedural myocardial damage (MD) is associated with increased risk of major in-hospital complications and adverse clinical events. The aim of this study was to evaluate the effects of on-clopidogrel platelet aggregation and CYP2C19-reduced-function gene variants on elective percutaneous coronary intervention (PCI)-related MD. We measured changes in serum high-sensitive troponin T (hs-TnT) levels, CYP2C19 genotype, and on-clopidogrel platelet aggregation (PA) using VerifyNow(®) P2Y12 system in 91 patients who received stent implantation (stent group). The control group comprised 30 patients who did not receive PCI. Blood samples were obtained before and 24h after PCI or coronary angiography (CAG). Patients of the stent group were divided into high and low MD groups based on the median value of hs-TnT level at 24h after PCI. Serum hs-TnT levels were significantly higher 24h after PCI (86.8±121.5pg/ml) compared with before PCI (9.4±5.3, p<0.001), whereas the levels were identical before and 24h after CAG in the control group. Simple logistic regression analysis demonstrated that MD correlated with age (p=0.014), estimated GFR (p=0.003), hemoglobin A1c (p=0.015), baseline serum hs-TnT (p=0.049), and stent length (p<0.001). Multiple logistic regression analysis identified old age, high hemoglobin A1c level, and long stent, but not CYP2C19 reduced-function allele or high on-clopidogrel PA, as independent predictors of elective PCI-related MD. The present study demonstrated no significant relation between peri-procedural MD and high on-clopidgrel PA associated with CYP2C19 reduced-function allele in patients undergoing elective PCI.