Clinical Impact of CYP2C19 Genotype on Clopidogrel-Based Antiplatelet Therapy After Percutaneous Coronary Intervention

Lee, SH; Jeong, YH; Hong, D; Choi, KH; Lee, JM; Park, TK; Yang, JH; Hahn, JY; Choi, SH; Gwon, HC; Jeong, MH; Kim, BK; Joo, HJ; Chang, K; Park, Y; Ahn, SG; Suh, JW; Lee, SY; Cho, JR; Her, AY; Kim, HS; Kim, MH; Lim, DS; Shin, ES; Song, YB; PTRG-DES Registry Investigators

doi:10.1016/j.jcin.2023.01.363

Coronary disease & ACS

Clinical Impact of CYP2C19 Genotype on Clopidogrel-Based Antiplatelet Therapy After Percutaneous Coronary Intervention

JACC Cardiovasc IntervPublished 8 Mar 2023Cohort study

Main findingResultAdjusted hazard ratio 1.42 95% CI 1.01–1.98

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Authors' conclusion

Among East Asians with clopidogrel-based antiplatelet therapy after DES implantation, CYP2C19 genotyping could stratify patients who were likely to have an increased risk of atherothrombotic events.

Study context

Population: East Asian patients on clopidogrel-based antiplatelet therapy after drug-eluting stent (DES) implantation (percutaneous coronary intervention (PCI)) who underwent CYP2C19 genotyping; 56.7% ACS
Participants: 8,163 patients

Exposure: CYP2C19 IM or PM vs RM or NM on clopidogrel-based antiplatelet therapy
RM or NMn = 3,098reference
IMn = 3,906
PMn = 1,159
Outcome: Composite of:
Cardiac death
MI
Stent thrombosis
Follow-up: 5 years after the index procedure

Methodological detailsmulticentre registry consortium, nationwide

Multicentre registry consortium
Nationwide

Main finding

As reported in the abstract

5 years

Adjusted hazard ratio

1.42

95% CI 1.01–1.98

P = 0.041

IM or PMvs RM or NM

HRadj 1.42 (95% CI 1.01–1.98); P = 0.041

Observational data: associations, not effects.

Further findings

Outcome	← Lower risk with IM or PM ←→ Higher risk with IM or PM →	HRadj (95% CI)	P value
Primary outcome in the first yearIM or PMvs RM or NM	0.20.5125	1.67 (1.10–2.55)	P = 0.016
Primary outcome, by clinical presentation (subgroup)IM or PMvs RM or NMACS	0.20.5125	1.88 (1.20–2.93)	P = 0.005
Primary outcome, by clinical presentation (subgroup)IM or PMvs RM or NMStable angina	0.20.5125	0.92 (0.54–1.55)	P = 0.751
	0.20.5125Adjusted hazard ratio (log scale)

Primary outcome, by clinical presentation (subgroup): interaction P = 0.028

Original publication

Clinical Impact of CYP2C19 Genotype on Clopidogrel-Based Antiplatelet Therapy After Percutaneous Coronary Intervention. JACC Cardiovasc Interv. Published 8 March 2023. doi:10.1016/j.jcin.2023.01.363

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