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

BACKGROUND: 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.

AIMS: 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.

METHODS: 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).

RESULTS: 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).

CONCLUSION: CYP2C19 polymorphism is significantly associated with risk of adverse clinical events in clopidogrel-treated patients.