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

 Seung Hun Lee  ;  Young-Hoon Jeong  ;  David Hong  ;  Ki Hong Choi  ;  Joo Myung Lee  ;  Taek Kyu Park  ;  Jeong Hoon Yang  ;  Joo-Yong Hahn  ;  Seung-Hyuck Choi  ;  Hyeon-Cheol Gwon  ;  Myung Ho Jeong  ;  Byeong-Keuk Kim  ;  Hyung Joon Joo  ;  Kiyuk Chang  ;  Yongwhi Park  ;  Sung Gyun Ahn  ;  Jung-Won Suh  ;  Sang Yeub Lee  ;  Jung Rae Cho  ;  Ae-Young Her  ;  Hyo-Soo Kim  ;  Moo Hyun Kim  ;  Do-Sun Lim  ;  Eun-Seok Shin  ;  Young Bin Song 
 JACC-CARDIOVASCULAR INTERVENTIONS, Vol.16(7) : 829-843, 2023-04 
Journal Title
Issue Date
Acute Coronary Syndrome* / drug therapy ; Acute Coronary Syndrome* / therapy ; Clopidogrel / adverse effects ; Cytochrome P-450 CYP2C19 / genetics ; Drug-Eluting Stents* ; Genotype ; Humans ; Percutaneous Coronary Intervention* / adverse effects ; Platelet Aggregation Inhibitors / adverse effects ; Ticlopidine / adverse effects ; Treatment Outcome
CYP2C19 genotype ; clopidogrel ; drug-eluting stent(s) ; percutaneous coronary intervention ; prognosis
Background: Although there is a growing body of evidence that CYP2C19 genotyping can be beneficial when considering treatment with clopidogrel after percutaneous coronary intervention (PCI), whether a genotype-guided strategy can be generally adopted in routine practice remains unclear among East Asians. Objectives: This study sought to investigate long-term outcomes of patients undergoing clopidogrel-based antiplatelet therapy after drug-eluting stent (DES) implantation according to CYP2C19 genotypes. Methods: From the nationwide multicenter PTRG-DES (Platelet function and genoType-Related long-term proGnosis in DES-treated patients) consortium, patients who underwent CYP2C19 genotyping were selected and classified according to CYP2C19 loss-of-function allele: rapid metabolizers (RMs) or normal metabolizers (NMs) vs intermediate metabolizers (IMs) or poor metabolizers (PMs). The primary outcome was a composite of cardiac death, myocardial infarction, and stent thrombosis at 5 years after the index procedure. Results: Of 8,163 patients with CYP2C19 genotyping, 56.7% presented with acute coronary syndrome. There were 3,098 (37.9%) in the RM or NM group, 3,906 (47.9%) in the IM group, and 1,159 (14.2%) in the PM group. IMs or PMs were associated with an increased risk of 5-year primary outcome compared with RMs or NMs (HRadj: 1.42; 95% CI: 1.01-1.98; P = 0.041), and the effect was more pronounced in the first year (HRadj: 1.67; 95% CI: 1.10-2.55; P = 0.016). The prognostic implication of being an IM and PM was significant in acute coronary syndrome patients (HRadj: 1.88; 95% CI: 1.20-2.93; P = 0.005) but not in those with stable angina (HRadj: 0.92; 95% CI: 0.54-1.55; P = 0.751) (interaction P = 0.028). Conclusions: 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. (Platelet Function and genoType-Related Long-term progGosis in DES-treated Patients: A Consortium From Multi-centered Registries [PTRG-DES]; NCT04734028) © 2023 American College of Cardiology Foundation
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Byeong Keuk(김병극) ORCID logo https://orcid.org/0000-0003-2493-066X
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