title: CYP2C19 genotype and early ischemic lesion recurrence in stroke patients treated with clopidogrel.
abstract: BACKGROUND
  Early recurrent ischemic lesions detected on diffusion-weighted imaging (DWI) have been proposed as a surrogate marker for clinical recurrence. We hypothesized that cytochrome P450 2C19 (CYP2C19) genotype influences the incidence of early recurrence on DWI in acute stroke patients treated with clopidogrel.
  
  
  METHODS
  We enrolled 76 Korean patients with acute ischemic stroke due to large artery atherosclerosis who were treated with clopidogrel. Early ischemic lesion recurrence was defined as new lesions separate from the index lesion. We compared the rates of early ischemic lesion recurrence on DWI based on the CYP2C19 genotypes.
  
  
  RESULTS
  Early recurrence on DWI was observed in 36 patients (47.4%). A total of 76 patients were classified into 3 phenotypic groups: extensive metabolizers (EMs; n = 27, 35.5%), intermediate metabolizers (IMs; n = 36, 47.4%), and poor metabolizers (PMs; n = 13, 17.1%). Early recurrence on DWI was more common in PMs (84.6%), followed by IMs (50.0%), and EMs (25.9%; P < .001). PMs had a significantly higher recurrence rate than EMs (P < .001). In multivariate analysis, CYP2C19 genotypes were independently associated with early DWI recurrence (for PMs: odds ratio, 19.3; 95% confidence interval, 3.15-117.56).
  
  
  CONCLUSIONS
  CYP2C19 genotypes are significantly associated with early lesion recurrence in Korean acute stroke patients treated with clopidogrel.
authors.affiliation: Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Tae-Dong
authors.initials: TD
authors.lastname: Jeong
authors.affiliation: Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Seung Min
authors.initials: SM
authors.lastname: Kim
authors.affiliation: Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Hyo Jin
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Woochang
authors.initials: W
authors.lastname: Lee
authors.affiliation: Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Sun U
authors.initials: SU
authors.lastname: Kwon
authors.affiliation: Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
authors.forename: Won-Ki
authors.initials: WK
authors.lastname: Min
authors.affiliation: Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. Electronic address: dwkang@amc.seoul.kr.
authors.forename: Dong-Wha
authors.initials: DW
authors.lastname: Kang
authors.affiliation: Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea. Electronic address: sailchun@amc.seoul.kr.
authors.forename: Sail
authors.initials: S
authors.lastname: Chun
mesh_terms: D000368:Aged; D044466:Asian People / Q000235:genetics; D001921:Brain / Q000473:pathology*; D002545:Brain Ischemia / Q000188:drug therapy / Q000235:genetics* / Q000473:pathology; D000077144:Clopidogrel; D065731:Cytochrome P-450 CYP2C19 / Q000235:genetics*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy / Q000235:genetics* / Q000473:pathology; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D065731:Cytochrome P-450 CYP2C19; D013988:Ticlopidine
keywords: CYP2C19; Clopidogrel; diffusion magnetic resonance imaging; genotype; recurrence; stroke