CYP2C19 Genotype has a Greater Prognostic Value in Specific Population Following Coronary Stenting
Background:
The prognostic value of CYP2C19 in post-PCI patients is still controversial in all-comer studies. The recently-published PHARMCLO trial with a limited sample indicates personalized pharmacogenomic approach may reduce adverse events. This study aimed to find the specific population that CYP2C19 genotype was applicable to.
Methods:
The perspective and registered cohort consisted of 10724 PCI patients in 2013, and 756 patients with genotyping of CYP2C19 were included. Prognostic value of CYP2C19 genotype was tested based on different clinical factors. The primary endpoint was major adverse cardio- and cerebro-vascular event (MACCE).
Results:
MACCE events at 2-year 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 predictor for MACCE 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). No significant difference in major bleeding (BARC gradeā„3) was found in three groups (2.5% vs. 2.1% vs. 0.8%, P=0.133). The Figure shows that prognostic value of CYP2C19 genotype could be detected in the following subgroups: male, age>60y, BMI>24kg/m2, SYNTAX score>15, current smokers and without chromic kidney disease (CKD).
Conclusions:
Utilizing of CYP2C19 genotype to guide post-PCI antiplatelet therapy might be appropriate in patients with the following characteristics: male, age>60y, BMI>24kg/m2, SYNTAX score>15, current smokers, and non-CKD. 