title: CYP2C19 phenotype, stent thrombosis, myocardial infarction, and mortality in patients with coronary stent placement in a Chinese population.
abstract: BACKGROUND
  Several studies have indicated that CYP2C19 loss-of-function polymorphisms have a higher risk of stent thrombosis (ST) after percutaneous coronary interventions (PCIs). However, this association has not been investigated thoroughly in a Chinese population. In this study, we aimed to determine the effect of CYP2C19*2 and CYP2C19*3 loss-of-function polymorphisms on the occurrence of ST and other adverse clinical events in a Chinese population.
  
  
  METHODS
  We designed a cohort study among 1068 consecutive patients undergoing intracoronary stent implantation after preloading with 600 mg of clopidogrel. CYP2C19*2 and CYP2C19*3 were genotyped by using polymerase chain reaction-restriction fragment length polymorphism analysis. The adverse clinical events recorded were ST, death, myocardial infarction (MI), and bleeding events. The primary end point of the study was the incidence of cumulative ST within 1 year after PCI. The secondary end point was other adverse clinical outcomes 1 year after the procedure.
  
  
  RESULTS
  The cumulative 1-year incidence of ST was 0.88% in patients with extensive metabolizers (EMs) (CYP2C19*1/*1 genotype), 4.67% in patients with intermediate metabolizers (IMs) (CYP2C19*1/*2 or *1/*3 genotype), and 10.0% in patients with poor metabolizers (PMs) (CYP2C19*2/*2, *2/*3, or *3/*3 genotype) (P<0.001). The one-year event-free survival was 97.8% in patients with EMs, 96.5% in patients with IMs, and 92.0% in patients with PMs (P = 0.014). Multivariate analysis confirmed the independent association of CYP2C19 loss-of-function allele carriage with ST (P = 0.009) and total mortality (P<0.05).
  
  
  CONCLUSIONS
  PM patients had an increased risk of ST, death, and MI after coronary stent placement in a Chinese population.
authors.affiliation: Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, PR China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Xie
authors.forename: Yi-Tong
authors.initials: YT
authors.lastname: Ma
authors.forename: Yi-Ning
authors.initials: YN
authors.lastname: Yang
authors.forename: Xiao-Mei
authors.initials: XM
authors.lastname: Li
authors.forename: Xiang
authors.initials: X
authors.lastname: Ma
authors.forename: Zhen-Yan
authors.initials: ZY
authors.lastname: Fu
authors.forename: Ying-Ying
authors.initials: YY
authors.lastname: Zheng
authors.forename: Bang-Dang
authors.initials: BD
authors.lastname: Chen
authors.forename: Fen
authors.initials: F
authors.lastname: Liu
mesh_terms: D000368:Aged; D000483:Alleles; D001189:Aryl Hydrocarbon Hydroxylases / Q000235:genetics*; D044466:Asian People; D000077144:Clopidogrel; D065731:Cytochrome P-450 CYP2C19; D005260:Female; D015870:Gene Expression; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000209:etiology / Q000235:genetics* / Q000401:mortality; D062645:Percutaneous Coronary Intervention; D010641:Phenotype; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011110:Polymorphism, Genetic; D019106:Postoperative Hemorrhage / Q000188:drug therapy / Q000209:etiology / Q000235:genetics* / Q000401:mortality; D015607:Stents / Q000009:adverse effects*; D016019:Survival Analysis; D013927:Thrombosis / Q000188:drug therapy / Q000209:etiology / Q000235:genetics* / Q000401:mortality; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D001189:Aryl Hydrocarbon Hydroxylases; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19; D013988:Ticlopidine
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