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Impacts of CYP2C19 Polymorphism and Clopidogrel Dosing on in-Stent Restenosis: A Retrospective Cohort Study in Chinese Patients

Authors
  • Zhang, Min1, 2
  • Wang, Jiangrong1
  • Zhang, Yong1
  • Zhang, Pei1
  • Jia, Zhisheng2
  • Ren, Manyi1
  • Jia, Xiaomeng1
  • Ma, Liping1
  • Gao, Mei1
  • Hou, Yinglong1
  • 1 Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014, Shandong
  • 2 Department of Cardiology, The Fifth People’s Hospital of Jinan, Jinan, 250022, Shandong
Type
Published Article
Journal
Drug Design Development and Therapy
Publisher
Dove Medical Press
Publication Date
Feb 19, 2020
Volume
14
Pages
669–676
Identifiers
DOI: 10.2147/DDDT.S242167
PMID: 32109992
PMCID: PMC7038774
Source
PubMed Central
Keywords
License
Green

Abstract

Objective This retrospective cohort study is to analyze the impacts of CYP2C19 polymorphism and clopidogrel dosing on in-stent restenosis (ISR) after coronary stenting. Methods Totally, 111 patients were included, who underwent percutaneous coronary intervention (PCI) with drug-eluting stent. Patients received clopidogrel treatment after the intervention on the background treatment with aspirin, based on the genotypes: 75 mg clopidogrel once each day for subjects without CYP2C19 loss-of-function (LOF) alleles (n=51; EM), 75 mg clopidogrel once each day (n=27; IM75) or twice each day (n=33; IM150) for subjects with one CYP2C19 LOF allele. ISR at 3–18 months after coronary stenting was assessed. Results ISR rate was significantly higher in the IM75 group (40.7%) than the EM group (11.8%). ISR rate in the IM150 group was lower than the IM75 group (6.1% vs 40.7%), and comparable to that in the EM group. Multivariate logistic regression showed that both CYP2C19 genotype and clopidogrel dosing were associated with the risk of ISR after adjusting the relevant confounding factors. ISR risk was higher in the IM patients than the EM patients. Patients with clopidogrel dose of 75 mg once each day had significantly higher risk of ISR than those with the dose of 75 mg twice each day. Conclusion Increased dose of clopidogrel may reduce the risk of ISR after PCI in CYP2C19 LOF allele(s) carriers. The presence of CYP2C19 LOF allele(s) increases the risk of ISR after stenting, which could be counteracted by the increased dose of clopidogrel.

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