Decreased platelet responsiveness to clopidogrel correlates with CYP2C19 and PON1 polymorphisms in atherosclerotic patients.

Clopidogrel and aspirin are the most commonly used medications worldwide for dual antiplatelet therapy after percutaneous coronary intervention. However, clopidogrel hyporesponsiveness related to gene polymorphisms is a concern. Populations with higher degrees of genetic admixture may have increased prevalence of clopidogrel hyporesponsiveness. To assess this, we genotyped CYP2C19, ABCB1, and PON1 in 187 patients who underwent percutaneous coronary intervention. Race was self-defined by patients. We also performed light transmission aggregometry with adenosine diphosphate (ADP) and arachidonic acid during dual antiplatelet therapy. We found a significant difference for presence of the CYP2C19*2 polymorphism between white and non-white patients. Although 7% of patients had platelet resistance to clopidogrel, this did not correlate with any of the tested genetic polymorphisms. We did not find platelet resistance to aspirin in this cohort. Multivariate analysis showed that patients with PON1 and CYP2C19 polymorphisms had higher light transmission after ADP aggregometry than patients with native alleles. There was no preponderance of any race in patients with higher light transmission aggregometry. In brief, PON1 and CYP2C19 polymorphisms were associated with lower clopidogrel responsiveness in this sample. Despite differences in CYP2C19 polymorphisms across white and non-white patients, genetic admixture by itself was not able to identify clopidogrel hyporesponsiveness.

Predictors of restenosis after percutaneous coronary intervention using bare-metal stents: a comparison between patients with and without dysglycemia.

The objective of this study was to identify intravascular ultrasound (IVUS), angiographic and metabolic parameters related to restenosis in patients with dysglycemia. Seventy consecutive patients (77 lesions) selected according to inclusion and exclusion criteria were evaluated by the oral glucose tolerance test and the determination of insulinemia after a successful percutaneous coronary intervention (PCI) with a bare-metal stent. The degree of insulin resistance was calculated by the homeostasis model assessment of insulin resistance (HOMA-IR). Six-month IVUS and angiogram follow-up were performed. Thirty-nine patients (55.7%) had dysglycemia. The restenosis rate in the dysglycemic group was 37.2 vs 23.5% in the euglycemic group (P = 0.299). The predictors of restenosis using bivariate analysis were reference vessel diameter (RVD): pound2.93 mm (RR = 0.54; 95%CI = 0.05-0.78; P = 0.048), stent area (SA): <8.91 mm(2) (RR = 0.66; 95%CI = 0.24-0.85; P = 0.006), stent volume (SV): <119.75 mm(3) (RR = 0.74; 95%CI = 0.38-0.89; P = 0.0005), HOMA-IR: >2.063 (RR = 0.44; 95%CI = 0.14-0.64; P = 0.027), and fasting plasma glucose (FPG): < or =108.8 mg/dL (RR = 0.53; 95%CI = 0.13-0.75; P = 0.046). SV was an independent predictor of restenosis by multivariable analysis. Dysglycemia is a common clinical condition in patients submitted to PCI. The degree of insulin resistance, FPG, RVD, SA, and SV were correlated with restenosis. SV was inversely correlated with an independent predictor of restenosis in patients treated with a bare-metal stent.

Predictors of restenosis after percutaneous coronary intervention using bare-metal stents: a comparison between patients with and without dysglycemia

The objective of this study was to identify intravascular ultrasound (IVUS), angiographic and metabolic parameters related to restenosis in patients with dysglycemia. Seventy consecutive patients (77 lesions) selected according to inclusion and exclusion criteria were evaluated by the oral glucose tolerance test and the determination of insulinemia after a successful percutaneous coronary intervention (PCI) with a bare-metal stent. The degree of insulin resistance was calculated by the homeostasis model assessment of insulin resistance (HOMA-IR). Six-month IVUS and angiogram follow-up were performed. Thirty-nine patients (55.7 percent) had dysglycemia. The restenosis rate in the dysglycemic group was 37.2 vs 23.5 percent in the euglycemic group (P = 0.299). The predictors of restenosis using bivariate analysis were reference vessel diameter (RVD): £2.93 mm (RR = 0.54; 95 percentCI = 0.05-0.78; P = 0.048), stent area (SA): <8.91 mm² (RR = 0.66; 95 percentCI = 0.24-0.85; P = 0.006), stent volume (SV): <119.75 mm³ (RR = 0.74; 95 percentCI = 0.38-0.89; P = 0.0005), HOMA-IR: >2.063 (RR = 0.44; 95 percentCI = 0.14-0.64; P = 0.027), and fasting plasma glucose (FPG): ≤108.8 mg/dL (RR = 0.53; 95 percentCI = 0.13-0.75; P = 0.046). SV was an independent predictor of restenosis by multivariable analysis. Dysglycemia is a common clinical condition in patients submitted to PCI. The degree of insulin resistance, FPG, RVD, SA, and SV were correlated with restenosis. SV was inversely correlated with an independent predictor of restenosis in patients treated with a bare-metal stent.

[Hypertrophic cardiomyopathy treated by interventional technique of septal reduction]. / Cardiomiopatia hipertrófica tratada por técnica intervencionista de redução septal.

A 75-year old woman with obstructive hypertrophic cardiomyopathy and class IV dyspnea refractory to medical management had relative contraindications for both pacemaker implantation and surgical approach. Percutaneous intervention was devised to perform the selective injection of absolute alcohol in the first septal branch of the left anterior descending coronary artery. This led to a limited septal infarction documented by ST elevation, enzymatic elevation and the appearance of complete right bundle branch block on the electrocardiogram. A baseline left ventricular outflow tract pressure gradient of 66mmHg was immediately abolished and no unexpected complications supervened. Currently, two months after the procedure, marked symptomatic relief is present and associated with the absence of obstructive outflow gradient, as documented by echocardiography.

Cardiomiopatia hipertrófica tratada por técnica intervencionista de reduçäo septal / Cardiomyopaty hipertrophic treatment through technique interval the reduction septal

Mulher de 75 anos com cardiomiopatia hipertrófica obstrutiva, com dispnéia classe IV, refratária ao tratamento clínico, apresentava contra-indicaçöes relativas para abordagens cirúrgica e de implante de marcapasso. Realizou-se procedimento intervencionista para injeçäo seletiva de álcool absoluto no 1§ ramo septal da artéria interventricular anterior. O infarto septal provocado acompanhou-se de liberaçäo enzimática, elevaçäo de ST e bloqueio de ramo direito do feixe de His. Näo houve complicaçöes inesperadas, e o gradiente da via ejetiva de ventrículo esquerdo, de 66mmHg, foi imediatamente abolido. Controle ecocardiográfico evidencia manutençäo desse resultado, até o momento, dois meses após o procedimento, em correspodência a marcante alívio sintomático.