title: The CYP2C19 genotype does not impact the long-term prognosis of patients with coronary artery disease.
abstract: BACKGROUND
  Cytochrome P450 (CYP) 2C19 plays a key role in clopidogrel activation and thus impacts the clinical outcome of patients with coronary artery disease (CAD). However, the majority of patients with CAD gradually discontinue clopidogrel after one year of discharge. This study explored whether the CYP2C19 gene polymorphism was associated with clinical events in patients with CAD after one year of discharge.
  
  
  METHODS
  Between July 2008 and July 2009, 506 patients with CAD that was confirmed by coronary angiography were enrolled in this study, and their CYP2C19 genotype was determined. The primary endpoint events included cardiovascular death, nonfatal myocardial infarction and nonfatal stroke. The secondary endpoint events included the components of the primary endpoint events, all-cause mortality and recurrent revascularisation.
  
  
  RESULTS
  The baseline clinical characteristics of CYP2C19*2-mutation carriers (homozygous *2/*2, n = 49; heterozygous *1/*2, n = 222) and non-carriers (wild-type allele *1/*1, n = 235) were comparable. The follow-up results showed that the incidence of adverse cardiovascular events within one year of discharge was significantly higher in carriers of the CYP2C19*2 homozygous genotype (*2/*2) than non-carriers (12.24% vs. 3.83%, adjusted hazard ratio (HR) 4.651, 95% confidence interval (CI) 1.566-13.814, p = 0.006). However, the follow-up results after one year of discharge showed that the risk of the CYP2C19*2 homozygous genotype were significantly reduced. New primary endpoint events during the second year after discharge had no significant correlation with the CYP2C19 genotype.
  
  
  CONCLUSIONS
  The risk of cardiovascular events in CAD patients with a homozygous CYP2C19*2 mutation was significantly higher than in other patients within the first year after discharge. However, the adverse impact of the CYP2C19*2 polymorphism was significantly reduced after one year of discharge.
authors: Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu 610041, China.
authors: Yong
authors: Y
authors: Peng
authors: Mao
authors: M
authors: Chen
authors: Xiao-jing
authors: XJ
authors: Liu
authors: Wei
authors: W
authors: Liu
authors: Qiao
authors: Q
authors: Li
authors: Hua
authors: H
authors: Chai
authors: Xin
authors: X
authors: Ren
authors: Xue-qin
authors: XQ
authors: Wang
authors: Zhen-gang
authors: ZG
authors: Zhao
authors: Chen
authors: C
authors: Zhang
authors: Xiao-lin
authors: XL
authors: Luo
authors: De-jia
authors: DJ
authors: Huang
mesh_terms: D000328:Adult; D000368:Aged; D001189:Aryl Hydrocarbon Hydroxylases / Q000235:genetics*; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000235:genetics* / Q000401:mortality; D065731:Cytochrome P-450 CYP2C19; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000378:metabolism; D011110:Polymorphism, Genetic; D011355:Prodrugs / Q000378:metabolism; D011379:Prognosis; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000378:metabolism
chemical_list: D010975:Platelet Aggregation Inhibitors; D011355:Prodrugs; D000077144:Clopidogrel; D001189:Aryl Hydrocarbon Hydroxylases; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19; D013988:Ticlopidine