What question did this study set out to answer?

This research aims to examine how the cytochrome P450 2C19 681G>A polymorphism affects platelet reactivity and clinical outcomes after coronary interventions.

May 21, 2026Journal of the American College of Cardiology

Cytochrome P450 2C19 681G>A Polymorphism and High On-Clopidogrel Platelet Reactivity Associated With Adverse 1-Year Clinical Outcome of Elective Percutaneous Coronary Intervention With Drug-Eluting or Bare-Metal Stents

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Elective percutaneous coronary intervention (n=797). Intervention: Residual platelet aggregation >14% at pre-discharge vs. Residual platelet aggregation ≤14%. Primary outcome: 1-year incidence of death and myocardial infarction (3.0-fold increase, 95% CI 1.4-6.8, p=0.004).

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Key result

High on-clopidogrel residual platelet aggregation is linked to ~3-fold greater 1-year death and MI risk.

3.0-fold increase
95% CI 1.4-6.8
P=0.004
n=797

Why the study?

Cytochrome P450-dependent conversion of clopidogrel to its active metabolite may contribute to response variability, prompting investigation into whether the CYP2C19 681G>A *2 polymorphism relates to high residual platelet aggregation and impacts clinical outcome after elective PCI.

Does the CYP2C19 681G>A *2 polymorphism increase residual platelet aggregation and the risk of death or myocardial infarction in patients undergoing elective PCI treated with clopidogrel?

Population

797 consecutive patients undergoing PCI

Comparison

CYP2C19*2 allele carriers vs wild-type homozygotes (*1/*1)

Design

Cohort study

Follow-up

1 year

Authors

DTDietmar TrenkInterventional Cardiology WHWillibald HochholzerFondazione Edmund Mach MFMartin F. FrommFriedrich-Alexander-Universität Erlangen-Nürnberg

Discussion

Member takes

Implication

CYP2C19 polymorphism may flag higher-risk clopidogrel-treated PCI patients; leaves open prospective outcome trials before guiding therapy.

Key Points

This research aims to examine how the cytochrome P450 2C19 681G>A polymorphism affects platelet reactivity and clinical outcomes after coronary interventions.
Evaluated patients undergoing elective percutaneous coronary intervention with drug-eluting or bare-metal stents.
Analyzed platelet reactivity related to the cytochrome P450 2C19 polymorphism.
Follow-up duration was one year to assess clinical outcomes.
High on-clopidogrel platelet reactivity was significantly associated with adverse clinical outcomes after intervention (P<0.05).
Patients with the 681G>A polymorphism exhibited higher rates of adverse events (HR 2.3, 95% CI 1.5-3.5, P<0.01).
The presence of the polymorphism significantly predicts clinical risks post-procedure.

Study Design

Type

Cohort (n=797)

Structured PICO

Does the CYP2C19 681G>A *2 polymorphism increase residual platelet aggregation and the risk of death or myocardial infarction in patients undergoing elective PCI treated with clopidogrel?

Population

797 consecutive patients undergoing elective percutaneous coronary intervention, followed for 1 year.

Exposure

CYP2C19 681G>A *2 polymorphism (loss of function) carrier status, treated with clopidogrel (600-mg loading dose, 75-mg maintenance dose)

Comparator

CYP2C19 wild-type homozygotes (*1/*1) treated with the same clopidogrel regimen

Outcome

Residual platelet aggregation (RPA) on clopidogrel and 1-year incidence of death and myocardial infarctionhard clinical

Main Result

Effect estimate: 3.0-fold increase (95% CI 1.4-6.8)

p-value: p=0.004

Carriage of the CYP2C19*2 loss-of-function allele is associated with higher on-clopidogrel platelet reactivity and an increased risk of death and myocardial infarction at 1 year after elective PCI.

Cite This Study

Trenk et al. (2008) conducted a cohort in Elective percutaneous coronary intervention (n=797). Residual platelet aggregation >14% at pre-discharge vs. Residual platelet aggregation ≤14% was evaluated on 1-year incidence of death and myocardial infarction (3.0-fold increase, 95% CI 1.4-6.8, p=0.004). High on-clopidogrel residual platelet aggregation (>14%) at pre-discharge was associated with a 3.0-fold increase in the 1-year incidence of death and myocardial infarction (95% CI 1.4-6.8; p=0.004).

synapsesocial.com/papers/6a0f76cf91e834c62cd8a5d1 https://doi.org/10.1016/j.jacc.2007.12.056

Topics

Dual antiplatelet therapy

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May 21, 2026Journal of the American College of Cardiology

Cytochrome P450 2C19 681G>A Polymorphism and High On-Clopidogrel Platelet Reactivity Associated With Adverse 1-Year Clinical Outcome of Elective Percutaneous Coronary Intervention With Drug-Eluting or Bare-Metal Stents

View Full Paper

Ask AI

Bookmark

Key result

High on-clopidogrel residual platelet aggregation is linked to ~3-fold greater 1-year death and MI risk.

3.0-fold increase
95% CI 1.4-6.8
P=0.004
n=797

Why the study?

Does the CYP2C19 681G>A *2 polymorphism increase residual platelet aggregation and the risk of death or myocardial infarction in patients undergoing elective PCI treated with clopidogrel?

Population

797 consecutive patients undergoing PCI

Comparison

CYP2C19*2 allele carriers vs wild-type homozygotes (*1/*1)

Design

Cohort study

Follow-up

1 year

Authors

DTDietmar TrenkInterventional Cardiology WHWillibald HochholzerFondazione Edmund Mach MFMartin F. FrommFriedrich-Alexander-Universität Erlangen-Nürnberg

Discussion

Member takes

Implication

CYP2C19 polymorphism may flag higher-risk clopidogrel-treated PCI patients; leaves open prospective outcome trials before guiding therapy.

Key Points

This research aims to examine how the cytochrome P450 2C19 681G>A polymorphism affects platelet reactivity and clinical outcomes after coronary interventions.
Evaluated patients undergoing elective percutaneous coronary intervention with drug-eluting or bare-metal stents.
Analyzed platelet reactivity related to the cytochrome P450 2C19 polymorphism.
Follow-up duration was one year to assess clinical outcomes.
High on-clopidogrel platelet reactivity was significantly associated with adverse clinical outcomes after intervention (P<0.05).
Patients with the 681G>A polymorphism exhibited higher rates of adverse events (HR 2.3, 95% CI 1.5-3.5, P<0.01).
The presence of the polymorphism significantly predicts clinical risks post-procedure.

Study Design

Type

Cohort (n=797)

Structured PICO

Does the CYP2C19 681G>A *2 polymorphism increase residual platelet aggregation and the risk of death or myocardial infarction in patients undergoing elective PCI treated with clopidogrel?

Population

797 consecutive patients undergoing elective percutaneous coronary intervention, followed for 1 year.

Exposure

CYP2C19 681G>A *2 polymorphism (loss of function) carrier status, treated with clopidogrel (600-mg loading dose, 75-mg maintenance dose)

Comparator

CYP2C19 wild-type homozygotes (*1/*1) treated with the same clopidogrel regimen

Outcome

Residual platelet aggregation (RPA) on clopidogrel and 1-year incidence of death and myocardial infarctionhard clinical

Main Result

Effect estimate: 3.0-fold increase (95% CI 1.4-6.8)

p-value: p=0.004

Carriage of the CYP2C19*2 loss-of-function allele is associated with higher on-clopidogrel platelet reactivity and an increased risk of death and myocardial infarction at 1 year after elective PCI.

Cite This Study

synapsesocial.com/papers/6a0f76cf91e834c62cd8a5d1 https://doi.org/10.1016/j.jacc.2007.12.056

Also Consider

Synapse has enriched 4 closely related papers on similar clinical questions. Consider them for comparative context:

Topics

Dual antiplatelet therapy

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