Cytochrome CYP2C19 polymorphism and risk of adverse clinical events in clopidogrel-treated patients: A meta-analysis based on 23,035 subjects

Abstract

Previous studies have investigated the relationship between CYP2C19 polymorphism and clinical prognosis in coronary artery disease patients treated with clopidogrel, but the results were inconsistent. To assess the impact of CYP2C19 polymorphism on the risk of adverse clinical events by performing a meta-analysis of relevant studies in the last few years. Prospective cohort studies or post-hoc analyses of randomized controlled trials were identified from the databases of PubMed/Medline, EMBASE and the Cochrane Library. Endpoints were fatal or non-fatal myocardial infarction, cardiovascular or all-cause death, definite or probable stent thrombosis, target vessel revascularization, target lesion revascularization, urgent revascularization, ischaemic stroke and bleeding. Pooled effects were measured by odds ratios (ORs) with 95% confidence intervals (CIs). A total of 21 studies involving 23,035 patients were included. Compared with non-carriers of the CYP2C19 variant allele, the carriers were found to have an increased risk of adverse clinical events (OR 1.50, 95% CI 1.21-1.87; P=0.0003), myocardial infarction (OR 1.62, 95% CI 1.35-1.95; P<0.00001), stent thrombosis (OR 2.08, 95% CI 1.67-2.60; P<0.00001), ischaemic stroke (OR 2.14, 95% CI 1.36-3.38; P=0.001) and repeat revascularization (OR 1.35, 95% CI 1.10-1.66; P=0.004), but not of mortality (P=0.500) and bleeding events (P=0.930). CYP2C19 polymorphism is significantly associated with risk of adverse clinical events in clopidogrel-treated patients.