Impacts of Polymorphism and Clopidogrel Dosing on in-Stent Restenosis: A Retrospective Cohort Study in Chinese Patients.

Objective: This retrospective cohort study is to analyze the impacts of polymorphism and clopidogrel dosing on in-stent restenosis (ISR) after coronary stenting.

Methods: Totally, 111 patients were included, who underwent percutaneous coronary intervention (PCI) with drug-eluting stent. Patients received clopidogrel treatment after the intervention on the background treatment with aspirin, based on the genotypes: 75 mg clopidogrel once each day for subjects without loss-of-function (LOF) alleles (n=51; EM), 75 mg clopidogrel once each day (n=27; IM75) or twice each day (n=33; IM150) for subjects with one LOF allele. ISR at 3-18 months after coronary stenting was assessed.

Results: ISR rate was significantly higher in the IM75 group (40.7%) than the EM group (11.8%). ISR rate in the IM150 group was lower than the IM75 group (6.1% vs 40.7%), and comparable to that in the EM group. Multivariate logistic regression showed that both genotype and clopidogrel dosing were associated with the risk of ISR after adjusting the relevant confounding factors. ISR risk was higher in the IM patients than the EM patients. Patients with clopidogrel dose of 75 mg once each day had significantly higher risk of ISR than those with the dose of 75 mg twice each day.

Conclusion: Increased dose of clopidogrel may reduce the risk of ISR after PCI in LOF allele(s) carriers. The presence of LOF allele(s) increases the risk of ISR after stenting, which could be counteracted by the increased dose of clopidogrel.