Introduction:

loss-of-function (LOF) genetic mutations in cytochrome P2C19 (CYP2C19) alleles can lead to impairment of clopidogrel metabolism. This can decrease the efficacy of clopidogrel in treating acute coronary syndrome, leading to increased risk of major adverse cardiac events (MACE) due to insufficient antiplatelet effect. In this study, we measured the prevalence of CYP2C19 gene LOF mutation named allele*2 and *3   among patients presenting with ischemic heart disease in a tertiary care setting. We also studied the effect of these alleles on the incidence of MACE in ischemic heart disease patients treated with clopidogrel.

Methods:

This is a prospective study that was held at the cardiology division at An-Najah National University Hospital, Nablus. Data collection started in September/2022 and ended in April/2023. The blood samples were collected and molecularly tested at the same hospital. Data collection was completed using a combination of patient-reported responses and electronic medical records. The chi-square test of independence was used to measure the correlation between CYP2C19 genotypes and incidence of MACE in patients treated for myocardial infarction at one, three, and six months post percutaneous coronary intervention. A p-value of less than 0.05 was considered statistically significant.

Results:

One hundred and forty patients were included in the study. Mean (standard deviation) age of the study sample age was 61.3 (10.1) years, 104 (74.3%) were males, 44 participants (31.4%) were taking clopidogrel at enrollment. The majority of patients (117/140, 83.6%) had the normal-no-allele*2- genotype, 20/140 (14.3%) were heterozygous for allele*2 and (2.1%) were homozygous for allele*2. In addition, the majority of patients (136/140, 97.1%) had the normal-no-allele*3- genotype, 4/140 (2.9%) were heterozygous for allele*3 and none were homozygous for allele*3.

At the first follow-up (one month), MACE was reported in 7/117 (6%) of patients with the normal -no allele*2-, 1/20 (5%) of the heterozygous, and none (0/3) of the homozygous genotypes. The chi-square test of independence found no significant difference between the three genotypes (p=0.89) in incidence of MACE at the one-month follow up. Similar results were found when evaluating data from the three months (p=0.95), and six months (p=0.76) follow ups. At the first follow-up (one month), MACE was reported in 8/136 (5.9%) of patients with the normal -no allele*3-, and none 0/4 (0%) of the heterozygous genotypes. The chi-square test of independence found no significant difference between the two genotypes (p=1.00) in incidence MACE at the one-month follow up. Similar results were found when evaluating data from the three months (p=0.95), and six months (p=0.76) follow ups.

Conclusion:

Alleles*2 and *3 exhibit a prevalence that is similar to what was reported previously, Alleles *2 and *3 genotypes did not have a statistically significant effect on incidence of MACE up to 6 months of follow-up.

Conference Title

ZIPC 2024

Conference Country

Jordan

Conference Date

Oct. 16, 2024 - Oct. 18, 2024

Conference Sponsor

جامعة النجاح