Original Article

CYP2C19 Genotype is an Independent Predictor of Adverse Cardiovascular Outcome in Iraqi Patients on Clopidogrel After Percutaneous Coronary Intervention

Mohammad, Ameen M. FIC^*; Al-Allawi, Nasir A. S. FRCPath^†

Departments of ^*Internal Medicine; and

^†Pathology, College of Medicine, University of Duhok, Kurdistan, Iraq.

Reprints: Nasir A. S. Al-Allawi, FRCPath, Department of Pathology, College of Medicine, University of Duhok, 9 Azadi Hospital Rd, Duhok 1014AM, Iraq (e-mail: [email protected]).

The authors report no conflicts of interest.

A. M. Mohammad and N. A. S. Al-Allawi have contributed equally.

Journal of Cardiovascular Pharmacology 71(6):p 347-351, June 2018. | DOI: 10.1097/FJC.0000000000000577

Abstract

To determine the impact of CYP2C19 genotyping on the occurrence of major adverse cardiovascular events (MACE), in cohort of Iraqi patients on clopidogrel after percutaneous coronary intervention (PCI), a total of 201 Iraqi patients undergoing the latter procedure were enrolled. All enrollees had their CYP2C19 genotyped using polymerase chain reaction and reverse hybridization. Genotyping revealed that CYP2C19 *1, *17, *2, and *8 allele frequencies were, respectively, 0.604, 0.276, 0.117, and 0.0026. After the exclusion of those with 2 loss of function alleles, 186 patients were available for follow-up as long as they were on clopidogrel, or until MACE occurred, which was encountered in 8.6% after a median of 12 months. Among predictors associated with MACE was the carriage of one CYP2C19 loss of function allele {hazard ratio (HR) 8.6 [confidence interval (CI) 3.15–23.4]; P < 0.0005}, hypertension [HR 3.74 (CI 1.06–13.16); P = 0.04], reduced ventricular function [HR 3.88 (1.43–10.54); P = 0.008], and history of previous myocardial infarction [HR 4.9 (CI 1.48–11.33); P = 0.007] by univariate analysis, although only CYP2C19 genotype remained significant by multivariate analysis [HR 11.88 (CI 3.25–43.44); P < 0.0005]. The latter observation favors CYP2C19 genotype–guided antiplatelet therapy and extending the use of alternative antiplatelet drugs to those with single loss of function allele after percutaneous coronary intervention.