Warning: file_get_contents(https://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=41390953&cmd=llinks): Failed to open stream: HTTP request failed! HTTP/1.1 500 Internal Server Error
in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 215
Prognostic Implication of CYP2C19 Genotype According to Clinical Risk Stratification After Drug-Eluting Stent Implantation #MMPMID41390953
Park HW; Lee JH; Jeong JO; Gorog DA; Tantry US; Kim BK; Joo HJ; Chang K; Hwang JY; Song YB; Ahn SG; Suh JW; Choi WG; Cho JR; Kang J; Lee SY; Kim HS; Kim MH; Lim DS; Shin ES; Gurbel PA; Jeong YH
Clin Pharmacol Ther 2025[Dec]; ? (?): ? PMID41390953show ga
The impact of CYP2C19 genotype in relation to clinical risk is unclear during clopidogrel treatment following drug-eluting stent (DES) implantation. This study aimed to evaluate the prognostic significance of CYP2C19 genotypes based on clinical risk stratification in DES-treated patients. From the nationwide multicenter PTRG-DES (Platelet function and genoType-Related long-term progGosis in DES-treated patients) consortium, patients were classified according to the presence of CYP2C19 loss-of-function (LoF) allele: rapid or normal metabolizers (RMs/NMs) vs. intermediate or poor metabolizers (IMs/PMs), and clinical risk was stratified using the CHADS-P(2)A(2)RC and TRS 2 degrees P scores. The primary endpoint (1 degrees EP) was a composite of cardiac death, myocardial infarction, and stent thrombosis during a 3-year follow-up. Among clopidogrel-treated patients with CYP2C19 genotyping (n = 8,163), IMs/PMs (62.1%) demonstrated an increased risk of 1 degrees EP compared with RMs/NMs (hazard ratio [HR]: 1.48; 95% confidence interval [CI]: 1.05-2.07; Log-rank P < 0.001), Most notable in those with high CHADS-P2A2RC (>/= 4) and TRS 2 degrees P (>/= 3) scores (HR(adj): 1.68; 95% CI: 1.01-2.80; P = 0.047 and HR(adj): 1.63; 95% CI: 1.05-2.54; P = 0.029, respectively). In patients with low scores, there was no difference in 1 degrees EP between IMs/PMs vs. RMs/NMs; however, an interaction was observed between acute and chronic coronary syndromes for both low CHADS-P(2)A(2)RC (HR(adj): 2.12; 95% CI: 1.11-4.03 and HR(adj): 0.68; 95% CI: 0.34-1.36; P(interaction) = 0.017) and TRS 2 degrees P scores (HR(adj): 2.34; 95% CI: 1.07-5.12 and HR(adj): 0.52; 95% CI: 0.22-1.17; P(interaction) = 0.008). Among clopidogrel-treated patients, the carriage of the CYP2C19 LoF allele was associated with higher ischemic risk, particularly in those with high clinical risk or an acute coronary syndrome presentation.
Clin+Pharmacol+Ther 2025 ; ? (?): ?
