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 (b 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 (b 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 (b coefficient=−1.626, SE=1.449, p=0.262 in the logistic regression model), nor did the CYP2C19*17 (b coefficient=−0.907, SE=1.438, p=0.528 in the logistic regression model) and ABCB1 3435 polymorphisms (b 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.

The aim is to study the paracoagulation phenomenon and stomach erosive ulcerous lesions relationship in patients with acute coronary syndrome. Material and methods. 443 patients with acute coronary syndrome were analyzed. 223 patients had positive paracoagulation samples. Anamnesis, coronary angiography, fibrogastroscopy, paracoagulation sample determination have been studied. Results. Positive paracoagulation samples in coagulogram of patients with acute coronary syndrome in 76% of cases associated with the stomach erosive ulcerous lesions. The phenomenon of paracoagulation is more likely to occur in smokers with diabetes and myocardial infarction (as the outcome of acute coronary syndrome), with multiply coronary arteries stenosis. Conclusion. The paracoagulation products investigation in acute coronary syndrome can be used to prognose stomach erosive ulcerous lesions.
Sapozhnikov A.N., Burmistrova V.G., Razin V.A., Mazurova O.V., Markovtseva M.V., Saikina О.A., Balandina T.L. Paracoag illation phenomenon and stomach lesions in patients with acute coronary syndrome // Saratov Journal of Medical Scientific Research, Vol. 10, Issue 2, 2014, pp. 271-275

Aim. To evaluate risk of repeated atherothrombotic events in patients survived acute coronary syndrome (ACS) and having poorly reduced platelet aggregation (proven by optical aggregometry) in response to acetylsalicylic acid (ASA) therapy. Material and methods. 200 patients with ACS (aged 56,6±9,2 y.o.) were included in the study. Platelet functional activity during ASA therapy was evaluated with laser aggregometer. ASA resistance was defined if the summarizing index of platelet aggregation (induced with ADP, 5 mμml/l) was 50% or higher during ASA therapy. Observation period was 18±6 months. Atherothrombotic events (unstable angina, myocardial infarction, stroke, cardiovascular death) were considered. Results. Lack ASA response rate was about 12%. Totally 22 repeated atherothrombotic events were registered: 5,6% among ASA sensitive patients and 50% - among ASA resistant patients. Repeated atherothrombotic events were registered in ASA resistance patients during first 14 days. ASA sensitive patients showed repeated atherothrombotic events in some months after ACS. The relative risk of cardiovascular event in ASA resistance patients was 8,92 (CI 95% 4,39; 17,84 р=0,05). Conclusion. The high level of the induced platelet aggregation (proven by laser aggregometry) points to high risk of repeated atherothrombotic events in patients with ACS.
Rational Pharmacother. Card. 2009; Iss. 6: P. 41-46.