CYP2C19 genotype has prognostic value in specific populations following coronary stenting

Background: The prognostic value of the CYP2C19 genotype in post-percutaneous coronary intervention (PCI) patients remains controversial. The recently-published, limited-sample PHARMCLO trial indicates a personalized pharmacogenomic approach may reduce adverse events. This study aimed to determine the prognostic value of CYP2C19 genotypes. Methods: The original cohort consisted of 10,724 PCI patients in 2013. 756 patients with genotyped CYP2C19 were included in our analysis. The CYP2C19 genotype prognostic value was tested based on different clinical factors. The primary endpoint was major adverse cardio- and cerebro-vascular event (MACCE). Results: MACCE 2-years post-PCI occurred in 19 patients (17.4%) in poor metabolizers (PM, CYP2C19 *2/*2, *2/*3, *3/*3), 43 patients (12.2%) in intermediate metabolizers (IM, CYP2C19 *1/*2 or *1/*3) and 27 patients (9.2%) in extensive metabolizers (EM, CYP2C19 *1/*1). PM was an independent MACCE predictor compared with EM (HR: 1.960, 95% CI: 1.139-3.372), but the difference between IM and PM was not significant (HR: 1.314, 95% CI: 0.843-2.048). Major bleeding (BARC grade >= 3) was not significantly different between the three groups (2.5% vs. 2.1% vs. 0.8%, P=0.133). Subgroup analysis showed that the CYP2C19 genotype prognostic value was present in the following subgroups: male, age >60 years, body mass index (BMI) >24 kg/m(2), SYNTAX score >15, current smokers, and patients without chronic kidney disease. Conclusions: Utilizing CYP2C19 genotype to guide post-PCI antiplatelet therapy might be appropriate in patients with the following characteristics: male, age >60 years, BMI >24 kg/m(2), SYNTAX score >15, current smokers, and non-chronic kidney disease (CKD) patients.

Automated summary

This study found that post-PCI patients with the CYP2C19 poor metabolizer genotype had the highest rate of major adverse cardio- and cerebro-vascular events (MACCE), while those with the extensive metabolizer genotype had the lowest rate. There was no significant difference in major bleeding rates between the three groups. The prognostic value of the CYP2C19 genotype was observed in male patients, those over 60 years old, with a BMI over 24 kg/m(2), SYNTAX score over 15, current smokers, and patients without chronic kidney disease.