Key result
CYP2C19 loss-of-function genotype linked to ~171% higher risk of in-stent restenosis vs wild-type.
Why the study?
The association between the CYP2C19 loss of function gene and in-stent restenosis after coronary stenting remains controversial, with prior studies showing conflicting results and small population sizes.
Does the CYP2C19 LOF genotype increase the risk of in-stent restenosis in patients treated with clopidogrel after coronary stenting?
Meta-Analysis (n=284)
Does the CYP2C19 LOF genotype increase the risk of in-stent restenosis in patients treated with clopidogrel after coronary stenting?
Effect estimate: OR 2.71 (95% CI 1.42-5.16)
Absolute Event Rate: 48.7% vs 33.5%
p-value: p=0.003
The presence of the CYP2C19 loss of function gene is associated with a significantly higher risk of in-stent restenosis in patients treated with clopidogrel after coronary stenting.
May identify clopidogrel-treated patients at elevated ISR risk; leaves open whether genotyping-guided therapy improves outcomes.
Background: In-stent restenosis (ISR) remains a major drawback in coronary stenting. The association between the CYP2C19 loss of function (LOF) gene and the prevalence of ISR after coronary stenting remains controversial. Previous studies have produced conflicting results and have been limited by their small population sizes. We conducted this systematic review and meta-analysis to determine the association between the presence of the CYP2C19 LOF gene and the prevalence of ISR. Methods: was applied to examine heterogeneities among the studies. Results: A total of 284 patients (four non-randomized controlled trial studies) were included in this study. Two hundred and six patients had wild-type genotypes, while 78 patients had the LOF genotype. Among the 78 patients with the LOF gene, 38 patients had an ISR. Meanwhile, of the 206 patients with a wild-type gene, 69 patients had an ISR. LOF gene was associated with a higher risk of ISR (OR 95% CI = 2.71 [1.42-5.16], P = 0.003). However, study-specific variability should be considered when applying these findings clinically. Conclusions: Patients with LOF genes, regardless of the allele variation, treated with clopidogrel, had a higher likelihood of ISR after coronary stenting.
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Pintaningrum et al. (2022) conducted a meta-analysis in Coronary in-stent restenosis (n=284). CYP2C19 loss of function (LOF) genotype vs. Wild-type genotype was evaluated on Prevalence of in-stent restenosis (ISR) (OR 2.71, 95% CI 1.42-5.16, p=0.003). The CYP2C19 loss of function genotype was associated with a higher risk of in-stent restenosis after coronary stenting compared to the wild-type genotype (OR 2.71; 95% CI 1.42-5.16; P=0.003).
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