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CLINICAL STUDIES: INTERVENTIONAL CARDIOLOGY

Pl^A polymorphism of glycoprotein IIIa and risk of adverse events after coronary stent placement

^a Deutsches Herzzentrum and 1. Medizinische Klinik rechts der Isar, Technische Universität München, Munich, Germany

Manuscript received June 22, 1999; revised manuscript received December 30, 1999, accepted March 24, 2000.

Reprint requests and correspondence: Dr. Adnan Kastrati, Deutsches Herzzentrum, Lazarettstr. 36, 80636 München, Germany
kastrati{at}dhm.mhn.de

OBJECTIVE

We designed this prospective study to test the hypothesis that platelet antigen (Pl^A) polymorphism of glycoprotein (GP) IIIa is associated with an increased risk for adverse events after coronary stent placement.

BACKGROUND

Platelets play a central role in arterial thrombosis. The Pl^A polymorphism of GP IIIa, a constituent of the fibrinogen receptor, may influence the platelet function and, thereby, the early outcome of patients after coronary stent placement.

METHODS

The study included 1,759 consecutive patients with stable or unstable angina and successful coronary stent placement. Platelet antigen genotypes were determined by allele-specific restriction enzyme analysis. The end point of the study was a composite of death, myocardial infarction and urgent revascularization during the first 30 days after stent placement.

RESULTS

The Pl^A genotype of the patients included was: 70.2% were homozygous for platelet antigen 1 (Pl^A1), 2.6% homozygous for platelet antigen 2 (Pl^A2), and 27.2% were heterozygous (Pl^A1/A2). The incidence of the composite end point was 5.5% among Pl^A2 carriers and 5.4% in homozygous Pl^A1 subjects (p = 0.94). It was 5.4% in Pl^A1/A1 patients, 4.8% in Pl^A1/A2 patients and 13.0% in Pl^A2/A2 patients (p = 0.06). The combined incidence of death or myocardial infarction was 4.3% in Pl^A1/A1 patients, 4.2% in Pl^A1/A2 patients and 13.0% in Pl^A2/A2 patients (p = 0.02).

CONCLUSIONS

The isolated presence of the Pl^A2 allele in heterozygous patients is not associated with any detectable increase in the risk for an adverse 30-day outcome after coronary stenting. This study suggests also that an increased risk is likely to be present in homozygous carriers of the Pl^A2 allele, but this should be confirmed in a much larger series of patients.

Abbreviations and Acronyms   CI = confidence interval   GP = glycoprotein   MI = myocardial infarction   MLD = minimal lumen diameter   PlA = Platelet Antigen

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