The impact of cytochrome P450 2C19 polymorphism on the occurrence of one-year in-stent restenosis in patients who underwent percutaneous coronary intervention: A case-match study

Abstract

ObjectiveIn this case-match study, we evaluated the impact of the CYP2C19*2 polymorphism in the occurrence of in-stent restenosis during a 1-year follow-up period despite adequate dual anti-platelet therapy in Iranian patients having undergone percutaneous coronary intervention (PCI).MethodsThis study, conducted at a tertiary referral heart center in Tehran, recruited 100 patients: 50 patients had in-stent restenosis after PCI during a 1-year follow-up and were compared to another 50 patients without in-stent restenosis who were individually matched according to sex. In order to evaluate the impact of the CYP2C19*2 polymorphism, case frequency matching was performed with respect to variables previously shown to be predictors of in-stent restenosis. The CYP2C19*2 polymorphism evaluated using real-time PCR methods.ResultsAmong all 100 patients (mean age=60.09±10.29: 72.0% male), 89 (89%) patients had wild (CYP2C19*1/CYP2C19*1) and 11% had a heterozygous (CYP2C19*1/CYP2C19*2) genotypes, and there was no patient with a completely mutant genotype (CYP2C19*2/CYP2C19*2). Conditional logistic regression analysis showed that there was no significant association between genotype CYP2C19*1/CYP2C19*2 and the occurrence of in-stent restenosis after PCI (OR=2.5, p value=0.273).ConclusionOur findings indicated that carrying a CYP2C19*2 allele with a functional CYP2C19*1 allele had no significant association with instent restenosis 1 year after PCI. The antiplatelet treatment strategy for non-functional allele carriers is still a matter of controversy. Further studies with larger sample sizes are necessary to determine the prevalence of non-functional alleles in various populations and to achieve a consensus about the effective treatment strategy.

CYP2C19*2 Allele Carrier Status and Coronary In-stent Restenosis: Is There an Association?

“…The findings from this study show that despite a higher proportion of CYP2C19*2 allele carriers exhibiting coronary ISR within 1 year compared to non-carriers, and *2 allele carriers being 4.08-times more likely to exhibit ISR than non-carriers, the association between CYP2C19*2 allele carrier status and development of coronary ISR was not statistically significant (p > 0.05). Our findings are similar to Nozari et al 25 who reported that the prevalence of ISR after PCI was higher in *2 allele carriers but without a statistically significant relationship, and contrast to Ruedlinger et al, 26 who identified non-carriers of the *2 allele with higher incidence of coronary ISR.…”

“…The Fisher's exact p-value obtained in our study (0.067) exceeds the 0.05 level of significance by only a small margin, despite the very small sample size (29 patients with ISR). Compared to our study, Nozari et al 25 had a larger sample of patients with ISR (50 patients) and a higher p-value (0.273) was obtained. Hence, given the small sample size, the findings from our study should not be ignored.…”

“…23,24 With respect to coronary ISR, a 2015 case-match study in an Iranian patient population indicated that the prevalence of ISR during a 1-year period after PCI was higher in patients who were carriers of CYP2C19*2; however, the association did not reach statistical significance. 25 In contrast, in a recent study by Ruedlinger et al, 26 undertaken in Chilean patients who underwent PCI, noncarriers of the CYP2C19*2 allele had a higher incidence of ISR.…”

Allele and Genotype Frequencies of CYP2C19 in Patients with Drug-Eluting Stents Following Percutaneous Coronary Intervention in Southwest of Iran

“…Nozari et al (21) in a case-match study assessed the role of CYP2C19*2 polymorphism in the occurrence of in-stent restenosis during a 1-year follow-up period in Iranian patients who underwent PCI. The results of this study showed no significant association with in-stent restenosis one year after PCI in patients with CYP2C19*1*2 genotype.…”

The impact of cytochrome P 450 2 C19 polymorphism on the occurrence of 1-year in-stent restenosis in patients who underwent percutaneous coronary intervention: A case-match study

“…In a recent manuscript, published in this issue Nozari et al ( 1 ) entitled “The impact of cytochrome P450 2C19 polymorphism on the occurrence of one-year in-stent restenosis in patients who underwent percutaneous coronary intervention: A case-match study.” evaluated the impact of cytochrome P450 2 (CYP2C19*2) polymorphism in the occurrence of in-stent restenosis among Iranian patient population.…”