In LAA stroke patients, CYP2C19 poor or intermediate metabolizers had a higher risk of recurrent ischemic events than extensive metabolizers (adjusted HR 2.33; 95% CI 1.28-4.24).
Observational (n=369)
Yes
Does CYP2C19 poor or intermediate metabolizer status increase the risk of recurrent symptomatic ischemic stroke or transient ischemic attack in patients with large-artery atherosclerotic stroke?
CYP2C19 poor or intermediate metabolizer status is associated with a significantly higher long-term risk of recurrent ischemic events in patients with large-artery atherosclerotic stroke, particularly those taking clopidogrel.
Effect estimate: adjusted HR 2.33 (95% CI 1.28-4.24)
BACKGROUND: CYP2C19 polymorphisms influence clopidogrel metabolism, which may influence long-term stroke prognosis. OBJECTIVES: The authors sought to investigate whether CYP2C19 polymorphisms were associated with long-term recurrent ischemic events in patients with acute ischemic stroke due to large-artery atherosclerosis (LAA). METHODS: The present study, comprising a sub-data set from the National Cerebral and Cardiovascular Center Genome Registry-a data registry from a multicenter, prospective, observational study-enrolled patients with LAA stroke within 7 days of stroke onset who consented to genotyping of CYP2C19 polymorphism between 2004 and 2022. Based on CYP2C19 polymorphisms, participants were assigned to 1 of 3 groups: extensive metabolizers (∗1/∗1), intermediate metabolizers (∗1/∗2, ∗1/∗3), and poor metabolizers (∗2/∗2, ∗2/∗3, ∗3/∗3). The primary endpoint was the recurrence of symptomatic ischemic stroke/transient ischemic attack. RESULTS: Among 369 participants with LAA stroke (96 females 26.0%; age, median Q1-Q3, 74 65-80 years) and a median follow-up of 5.1 years, poor or intermediate metabolizers (PM/IMs) (n = 164) had a significantly higher risk of recurrent symptomatic ischemic stroke transient ischemic attack than extensive metabolizers (n = 205) (adjusted HR: 2.33; 95% CI: 1.28-4.24). Furthermore, restricting the analysis to patients taking clopidogrel, PM/IMs exhibited a similarly significant risk (adjusted HR: 5.26; 95% CI: 1.87-14.56). CONCLUSIONS: In patients with LAA stroke, CYP2C19 PM/IMs had a significantly higher long-term recurrence rate of ischemic events than extensive metabolizers.
Yoshimoto et al. (Sat,) conducted a observational in acute ischemic stroke due to large-artery atherosclerosis (LAA) (n=369). CYP2C19 poor or intermediate metabolizers vs. CYP2C19 extensive metabolizers was evaluated on recurrence of symptomatic ischemic stroke/transient ischemic attack (adjusted HR 2.33, 95% CI 1.28-4.24). In LAA stroke patients, CYP2C19 poor or intermediate metabolizers had a higher risk of recurrent ischemic events than extensive metabolizers (adjusted HR 2.33; 95% CI 1.28-4.24).