Evidence mapPaperPMID 40459439Full record

ArticleClinical pharmacology and therapeutics2025

CYP2C19 Polymorphisms and Clinical Outcomes Following Percutaneous Coronary Intervention in the Million Veteran Program.

Catherine Chanfreau-Coffinier, Kevin A Friede, Mary E Plomondon, Kyung Min Lee, Zhenyu Lu, Tia Dinatale, Scott L DuVall, Jason L Vassy, Stephen W Waldo, John H Cleator and 11 more

Abstract read
In one paragraph

Article in Clinical pharmacology and therapeutics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

  • Update of
    2023
5 · Who and what money

Authors and funding

21 authors.

Catherine Chanfreau-CoffinierVA Salt Lake City Heath Care System, Salt Lake City, Utah, USA.ORCID https://orcid.org/0000-0002-4663-8953
Kevin A FriedeDivision of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.ORCID https://orcid.org/0000-0001-5179-5075
Mary E PlomondonCART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, DC, USA.
Kyung Min LeeVA Salt Lake City Heath Care System, Salt Lake City, Utah, USA.
Zhenyu LuVA Salt Lake City Heath Care System, Salt Lake City, Utah, USA.
Tia DinataleVA Salt Lake City Heath Care System, Salt Lake City, Utah, USA.
Scott L DuVallVA Salt Lake City Heath Care System, Salt Lake City, Utah, USA.ORCID https://orcid.org/0000-0002-4898-3865
Jason L VassyVA Boston Healthcare System, Harvard Medical School, and Brigham and Women's Hospital, Boston, Massachusetts, USA.ORCID https://orcid.org/0000-0001-6113-5564
Stephen W WaldoCART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, DC, USA.
John H CleatorCentennial Heart at Skyline Medical Center, Nashville, Tennessee, USA.
Thomas M MaddoxWashington University School of Medicine in St. Louis, St. Louis, Missouri, USA.
Daniel J RaderUniversity of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Themistocles L AssimesVA Palo Alto Healthcare System, Stanford University, Palo Alto, California, USA.ORCID https://orcid.org/0000-0003-2349-0009
Scott M DamrauerUniversity of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Philip S TsaoVA Palo Alto Healthcare System, Stanford University, Palo Alto, California, USA.
Kyong-Mi ChangUniversity of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.ORCID https://orcid.org/0000-0001-6811-9364
Deepak VooraDurham VA Healthcare System, Duke University, Durham, North Carolina, USA.ORCID https://orcid.org/0000-0003-0015-5179
Julie A LynchVA Salt Lake City Heath Care System, Salt Lake City, Utah, USA.ORCID https://orcid.org/0000-0003-0108-2127
Jay GiriUniversity of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
VA Million Veteran Program
Sony TutejaUniversity of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.ORCID https://orcid.org/0000-0001-7007-3289

Funding

BLRD VA I01 BX003362
6 · The paper itself

Abstract

CYP2C19 loss-of-function (LOF) alleles decrease the antiplatelet effect of clopidogrel following percutaneous coronary intervention (PCI) in patients presenting with acute coronary syndrome (ACS). The impact of genotype in patients undergoing PCI for stable ischemic heart disease (SIHD) in real-world populations is less clear. We determined time to major adverse cardiac event (MACE), defined as the composite of cardiovascular death, stroke, or myocardial infarction, within 12 months following PCI in the VA Million Veteran Program (MVP) participants treated with clopidogrel from 1/1/2009 to 9/30/2017. Among 9061 Veterans (mean age 66.4 ± 8.7 years, 98% male, 13% Black); 43% had ACS, 57% had SIHD, and 28% carried a CYP2C19 LOF allele. In total, 619 patients (6.8%) experienced MACE, 317 (8.2%) in the ACS group and 302 (5.8%) in the SIHD group. Overall, a trend toward increased MACE risk was seen in the LOF carriers vs. non-carriers (adjusted hazard ratio [aHR] 1.13, confidence interval [95% CI] 0.98-1.31, P = 0.097), with a stronger risk among those presenting with ACS (aHR 1.20, 95% CI 0.98-1.47; P = 0.083). In post hoc analyses, LOF was associated with a significantly increased risk of MACE among younger (< 66 years) patients with ACS (aHR 1.41 [1.04-1.91], P = 0.028); however, no difference in risk was observed among older patients (aHR 1.07, 95% CI 0.80-1.40, P = 0.676). There was no impact of genotype in patients with SIHD (aHR 1.09, 95% CI 0.82-1.44, P = 0.565). Clinical factors may be more important than CYP2C19 genotype in determining the risk of MACE in older Veterans treated with clopidogrel undergoing PCI for ACS.

Indexed as

Acute Coronary SyndromeClopidogrelCytochrome P-450 CYP2C19Myocardial IschemiaPercutaneous Coronary InterventionPlatelet Aggregation InhibitorsAgedFemaleGenotypeHumansMaleMiddle AgedMyocardial InfarctionPolymorphism, GeneticRisk FactorsTreatment OutcomeClopidogrelCYP2C19 protein, humanCytochrome P-450 CYP2C19Platelet Aggregation Inhibitors

Identifiers

PMID40459439
PMCPMC12439012

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.