Cytochrome P450 2C19 Polymorphisms and Its Association With Major Adverse Cardiac Events in Post-coronary Intervention Patients on Clopidogrel in the Tertiary Care Center
Why the study?
Clopidogrel resistance due to genetic heterogeneity increases the risk of MACEs, prompting an evaluation of the association between CYP450 2C19 polymorphisms and MACEs in post-coronary intervention patients on clopidogrel.
Do abnormal CYP2C19 phenotypes increase the risk of major adverse cardiac events in post-coronary intervention patients on clopidogrel?
Population
72 acute coronary syndrome patients started on clopidogrel following coronary intervention
Comparison
Abnormal phenotypes (CYP2C19*2 & *3) vs normal phenotype (CYP2C19*1)
Design
Prospective observational study
Follow-up
two years
Authors
Discussion
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Implication
Abnormal CYP2C19 phenotypes associated with higher post-PCI MACE on clopidogrel; hypothesis-generating for genotype-guided therapy trials.
Key Points
- This study aims to evaluate the link between CYP450 2C19 polymorphisms and the occurrence of major adverse cardiac events (MACEs) in patients treated with clopidogrel after coronary intervention.
- Conducted a prospective observational study on acute coronary syndrome patients post-coronary intervention.
- Enrolled 72 patients categorized into normal (CYP2C19*1) and abnormal (CYP2C19*2 & *3) genotypes.
- Followed patients for two years to compare MACEs over the first and second year.
- In the first year, 19 MACEs were identified; during the second year, 27 MACEs occurred, indicating an increased trend.
- First-year STEMI occurred in 3 (9.1%) abnormal patients vs 0 (0%) normal (p=0.183).
- During the second year, NSTEMI was notably higher in abnormal patients (9, 29%) compared to normal (4, 10.3%) with p=0.045.
Structured PICO
Do abnormal CYP2C19 phenotypes increase the risk of major adverse cardiac events in post-coronary intervention patients on clopidogrel?
P
Population
72 acute coronary syndrome patients, mean age 67.71 ± 9.968, started on clopidogrel following coronary intervention.
I
Intervention
Abnormal CYP2C19 phenotypes (CYP2C19*2 & *3) receiving clopidogrel
C
Comparator
Normal CYP2C19 phenotype (CYP2C19*1) receiving clopidogrel
O
Outcome
Major adverse cardiac events (MACEs) during the first and second yearcomposite
Patients with abnormal CYP2C19 phenotypes (*2 and *3) have a significantly higher risk of recurrent MACE following coronary intervention while on clopidogrel compared to those with normal phenotypes.
Cite This Study
Kambhampati et al. (2023) studied this question.