CYP2C19 polymorphism and clinical outcomes of patients with carotid artery stenting

Aim: To explore the association between cytochrome P450 family 2 subfamily C member 19 (CYP2C19) and clinical outcomes in patients undergoing carotid artery stenting (CAS). Methods: This single-center, retrospective cohort study consecutively enrolled patients undergoing CAS and CYP2C19 polymorphism examination at the First Affiliated Hospital of Zhejiang University from January 2022 to November 2023. CYP2C19 polymorphisms were categorized into three groups based on their genotype: rapid, poor, and intermediate metabolizers. The primary outcome was stent thrombosis. Secondary outcomes included death, acute ischemic stroke or transient ischemic attack, acute coronary syndromes, and symptomatic bleeding. Logistic regression was used to evaluate the relative risk of outcomes in rapid metabolizers undergoing CAS compared with non-rapid metabolizers. Statistically significantly different variables among the three groups were added to the multivariable regression. Results: A total of 196 patients were included in the final analysis, of whom 91.3% were males. The mean age was 69.8 ± 6.9 years. Fifty-eight patients were categorized as rapid metabolizers, 31 as poor metabolizers, and 107 as intermediate metabolizers. No significant difference in the incidence of stent thrombosis was found among the three groups within 90 days after CAS ( p = 0.685) and over 90 days after CAS ( p = 0.593). The rapid metabolizer group had a higher risk of stent thrombosis than the poor metabolizer group over the entire follow-up period (3.4% vs 3.2%, odds ratio [OR] = 0.785, 95% confidence interval [CI] = 0.147-4.181, p = 0.777), with no significant difference between the two groups within 90 days after CAS (1.7% vs 3.2%, OR = 0.650, 95% CI = 0.092-4.605, p = 0.667) and over 90 days after CAS (0.0% vs 1.7%, OR = 1461, 95% CI = 0.000-, p = 0.998). Meanwhile, no significant difference was observed between the two groups regarding the incidence of death, IS or TIA, acute coronary syndromes, and symptomatic bleeding at the three time points, with or without the inclusion of covariates. Similarly, the relative risk of primary and secondary outcomes was not significant in the rapid compared with intermediate metabolizer groups at all time points. Conclusion: CYP2C19 polymorphism is not associated with the clinical outcome in patients undergoing CAS. However, random controlled trials are needed to validate this finding.