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
Reference42 articles.
1. Capodanno, D, Alfonso, F, Levine, GN, Valgimigli, M, Angiolillo, DJ. ACC/AHA vs. ESC guidelines on dual antiplatelet therapy: JACC guideline comparison. J Am Coll Cardiol 2018;72:2915–31. https://doi.org/10.1016/j.jacc.2018.09.057. 2. Sangkuhl, K, Klein, TE, Altman, RB. Clopidogrel pathway. Pharmacogenetics Genom 2010;20:463–5. https://doi.org/10.1097/fpc.0b013e3283385420. 3. Aradi, D, Komócsi, A, Vorobcsuk, A, Rideg, O, Tokés-Füzesi, M, Magyarlaki, T, et al.. Prognostic significance of high on-clopidogrel platelet reactivity after percutaneous coronary intervention: systematic review and meta-analysis. Am Heart J 2010;160:543–51. https://doi.org/10.1016/j.ahj.2010.06.004. 4. Scott, SA, Sangkuhl, K, Stein, CM, Hulot, JS, Mega, JL, Roden, DM, et al.. Clinical Pharmacogenetics Implementation Consortium guidelines for CYP2C19 genotype and clopidogrel therapy: 2013 update. Clin Pharmacol Ther 2013;94:317–23. https://doi.org/10.1038/clpt.2013.105. 5. Dangas, GD, Claessen, BE, Caixeta, A, Sanidas, EA, Mintz, GS, Mehran, R. In-stent restenosis in the drug-eluting stent era. J Am Coll Cardiol 2010;56:1897–907. https://doi.org/10.1016/j.jacc.2010.07.028.
Cited by
1 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献
1. How to Become a Successful Hospital and Community Pharmacist;Career Options in the Pharmaceutical and Biomedical Industry;2023
|
|