CYP2C19*2 genetic polymorphism and incidence of in-stent restenosis in patients on clopidogrel: a matched case-control study

Author:

Osama Sara1,Wirth Francesca1ORCID,Zahra Graziella2,Barbara Christopher2,Xuereb Robert G.3,Camilleri Liberato4,Azzopardi Lilian M.1

Affiliation:

1. Department of Pharmacy , Faculty of Medicine and Surgery, University of Malta , Msida , Malta

2. Department of Pathology , Molecular Diagnostics Unit, Mater Dei Hospital , Msida , Malta

3. Department of Cardiology , Mater Dei Hospital , Msida , Malta

4. Department of Statistics and Operations Research , Faculty of Science, University of Malta , Msida , Malta

Abstract

Abstract Objectives The cytochrome P450 2C19*2 (CYP2C19*2) genetic polymorphism is associated with reduced clopidogrel bioactivation, increasing the risk of atherothrombotic complications after percutaneous coronary intervention (PCI). In-stent restenosis (ISR) is a complication that limits the long-term prognosis of PCI. The aim was to investigate the association between presence of the CYP2C19*2 allele and ISR within one-year after PCI in patients prescribed dual antiplatelet therapy with aspirin and clopidogrel. Methods Sixty patients with angiographically-confirmed drug eluting stent (DES)-ISR within 12 months post-PCI when on DAPT with aspirin and clopidogrel were retrospectively identified (Cases). Another 60 patients with no documented ISR post-PCI in the study period (Controls) were case-matched for age, gender, ethnicity, diabetes mellitus and estimated glomerular filtration rate value, and were invited for CYP2C19*2 genotyping. The association between presence of the CYP2C19*2 allele and ISR was analysed using the Fisher’s Exact test and binary logistic regression. Results Twenty-six (43.3%) cases and 5 (8.3%) controls were carriers of one or two CYP2C19*2 alleles. As to non-carrier status of the CYP2C19*2 allele, 34 (56.7%) cases and 55 (91.7%) controls were identified. The association between CYP2C19*2 carrier status and DES-ISR within one-year post-PCI was statistically significant (p<0.001) in both the univariate and multivariate analysis. Conclusions The proportion of patients who were carriers of one or two CYP2C19*2 alleles who presented with DES-ISR within one-year post-PCI while on clopidogrel was significantly higher compared to patients with no documented ISR.

Publisher

Walter de Gruyter GmbH

Subject

Pharmacology (medical),General Pharmacology, Toxicology and Pharmaceutics

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