March 2, 1999Circulation159 citationsOpen Access
View Full PaperPl A Polymorphism of Platelet Glycoprotein IIIa and Risk of Restenosis After Coronary Stent Placement
Key Result
The PlA2 allele of platelet glycoprotein IIIa was associated with a higher risk of angiographic restenosis after coronary stenting compared to its absence (47% vs 38%; OR 1.42; 95% CI 1.09-1.84).
Study Design
Type
Cohort (n=1,150)
Structured PICO
Does the PlA2 allele of platelet glycoprotein IIIa increase the risk of angiographic restenosis in patients after coronary stent placement?
P
Population
1,150 consecutive patients with successful coronary stent placement followed for 6 months with coronary angiography to assess restenosis.
E
Exposure
Presence of the PlA2 allele (heterozygous PlA1/A2 or homozygous PlA2) of platelet glycoprotein IIIa
C
Comparator
Absence of the PlA2 allele (homozygous for PlA1)
O
Outcome
Incidence of angiographic restenosis (≥50% diameter stenosis) at 6-month follow-upsurrogate
The PlA2 allele of platelet glycoprotein IIIa is an independent risk factor for angiographic restenosis after coronary stent placement, with the risk being more pronounced in homozygous carriers and women.
Main Result
Odds Ratio: 1.42 (95% CI 1.09–1.84)
Absolute Event Rate: 47% vs 38%
Abstract
BACKGROUND: Platelets play a central role in the process of restenosis after percutaneous coronary interventions. A polymorphism of platelet glycoprotein IIIa (PlA) has been associated with a higher risk of coronary thrombosis. We designed this prospective study to test the hypothesis that PlA polymorphism of glycoprotein IIIa is associated with an increased risk for restenosis after coronary stent placement. METHODS AND RESULTS: The study included 1150 consecutive patients with successful coronary stent placement and 6-month follow-up with coronary angiography. The end point of the study was the incidence of angiographic restenosis (>/=50% diameter stenosis) at follow-up. Of the 1150 patients, 72.5% were homozygous for PlA1, 24.7% were heterozygous (PlA1/A2), and 2.8% were homozygous for PlA2. Patients with the PlA2 allele demonstrated a significantly higher restenosis rate than did those without (47% versus 38%; OR, 1.42; 95% CI, 1.09 to 1.84). The risk was highest in homozygous carriers of PlA2 (53.1% restenosis rate). After adjustment for several clinical and angiographic characteristics, the presence of the PlA2 allele remained a significantly independent risk factor for restenosis (adjusted OR, 1.35; 95% CI, 1.07 to 1.70). The influence of the PlA2 allele on restenosis was stronger in women. Women with PlA2 had a restenosis rate of 52% compared with the 33% incidence among women homozygous for PlA1 (OR, 2.21; 95% CI, 1.27 to 3.85). CONCLUSIONS: This study showed a significant association between the PlA polymorphism of glycoprotein IIIa and the risk of restenosis after coronary stent placement. The risk was more pronounced in patients homozygous for PlA2 allele and in female patients.