Key result
Homozygous CYP2C19*2 is linked to an ~6-fold higher risk of major cardiovascular events in ACS.
Why the study?
The impact of different CYP2C19*2 polymorphisms on clinical outcomes and their predictive value combined with classic risk factors in ACS patients was unclear.
Does CYP2C19*2 polymorphism predict adverse clinical outcomes in patients with acute coronary syndromes?
Cohort (n=497)
No
Does CYP2C19*2 polymorphism predict adverse clinical outcomes in patients with acute coronary syndromes?
Homozygosity for the CYP2C19*2 variant is an independent predictor of adverse cardiovascular events in ACS patients and improves risk prediction when combined with classic risk factors.
Answers are grounded in this paper and cite their sources.
Homozygous CYP2C19*2 independently predicted higher ACS event risk; leaves open whether adding genotype to GRACE or Killip improves stratification.
OBJECTIVES: To assess the impact of different CYP2C19*2 polymorphisms on clinical outcomes and the effects of CYP2C19*2 polymorphism on predicting clinical outcomes in association with classic risk factors in patients with acute coronary syndromes (ACS). METHODS: Between July 2008 and September 2009, 497 consecutive patients with ACS who were admitted to the West China Hospital of Sichuan University were enrolled and underwent CYP2C19*2 determination. The clinical outcomes were the composite of cardiovascular death, nonfatal myocardial infarction and nonfatal stroke. RESULTS: Baseline characteristics were balanced between noncarrier, heterozygous and homozygous groups of the CYP2C19*2 variant. The clinical endpoint occurred more frequently in the homozygous group (HR 4.86, CI 1.62-14.56, p = 0.005). After multivariable analysis, the CYP2C19*2 genetic variant was an independent predictor of cardiovascular events (HR 5.96, CI 1.77-20.03, p = 0.0039) as well as GRACE score and Killip class. The combination of CYP2C19*2 with GRACE score and Killip class increases the potential to predict adverse outcomes. CONCLUSIONS: Homozygosity (A/A) for CYP2C19*2 mutant is an independent determinant of prognosis in patients with ACS. The combination of CYP2C19*2 polymorphism with classic risk factors may be a useful tool to predict the risk of cardiovascular events.
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Yan et al. (2011) conducted a cohort in Acute coronary syndromes (ACS) (n=497). CYP2C19*2 polymorphism (homozygous) vs. Noncarrier and heterozygous groups was evaluated on Composite of cardiovascular death, nonfatal myocardial infarction and nonfatal stroke (HR 5.96, 95% CI 1.77-20.03, p=0.0039). Homozygosity for the CYP2C19*2 variant was an independent predictor of cardiovascular death, nonfatal MI, and nonfatal stroke in patients with ACS (HR 5.96; 95% CI 1.77-20.03; p=0.0039).
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