Key result
The CYP2C19*2 polymorphism was associated with a higher risk of MACE in CAD patients on clopidogrel (RR 1.28; 95% CI 1.06-1.54; p=0.009), but routine testing is not recommended due to low PPV.
Why the study?
Does the presence of CYP2C19*2 or ABCB1-C3435T polymorphism increase the risk of adverse cardiovascular events in CAD patients on clopidogrel?
Population
19,601 coronary artery disease (CAD) patients on clopidogrel from 14 trials
Comparison
Presence of CYP2C19*2 or ABCB1-C3435T polymorphism vs Absence of the respective polymorphism
Design
Meta-analysis
Authors
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Reinforces against routine CYP2C19*2 testing in CAD on clopidogrel; confirms MACE association yet leaves utility open due to low PPV.
Meta-Analysis (n=19,601)
Does the presence of CYP2C19*2 or ABCB1-C3435T polymorphism increase the risk of adverse cardiovascular events in CAD patients on clopidogrel?
Relative Risk: 1.28 (95% CI 1.06–1.54)
p-value: p=0.009
Although the CYP2C19*2 polymorphism is associated with increased adverse cardiovascular events in CAD patients on clopidogrel, routine genetic testing is not recommended due to its low positive predictive value.
Singh et al. (2012) conducted a meta-analysis in coronary artery disease (n=19,601). CYP2C19*2 and ABCB1-C3435T polymorphisms vs. Absence of polymorphisms was evaluated on major adverse cardiovascular events (MACE) (RR 1.28, 95% CI 1.06-1.54, p=0.009). The CYP2C19*2 polymorphism was associated with a higher risk of MACE in CAD patients on clopidogrel (RR 1.28; 95% CI 1.06-1.54; p=0.009), but routine testing is not recommended due to low PPV.
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