Prognostic Implication of <i>CYP2C19</i> Genotype According to Clinical Risk Stratification After Drug‐Eluting Stent Implantation
Bibliographic record
Abstract
The impact of CYP2C19 genotype in relation to clinical risk is unclear during clopidogrel treatment following drug‐eluting stent (DES) implantation. This study aimed to evaluate the prognostic significance of CYP2C19 genotypes based on clinical risk stratification in DES‐treated patients. From the nationwide multicenter PTRG‐DES (Platelet function and genoType‐Related long‐term progGosis in DES‐treated patients) consortium, patients were classified according to the presence of CYP2C19 loss‐of‐function (LoF) allele: rapid or normal metabolizers (RMs/NMs) vs. intermediate or poor metabolizers (IMs/PMs), and clinical risk was stratified using the CHADS‐P 2 A 2 RC and TRS 2°P scores. The primary endpoint (1°EP) was a composite of cardiac death, myocardial infarction, and stent thrombosis during a 3‐year follow‐up. Among clopidogrel‐treated patients with CYP2C19 genotyping ( n = 8,163), IMs/PMs (62.1%) demonstrated an increased risk of 1°EP compared with RMs/NMs (hazard ratio [HR]: 1.48; 95% confidence interval [CI]: 1.05–2.07; Log‐rank P < 0.001), Most notable in those with high CHADS‐P2A2RC (≥ 4) and TRS 2°P (≥ 3) scores (HR adj : 1.68; 95% CI: 1.01–2.80; P = 0.047 and HR adj : 1.63; 95% CI: 1.05–2.54; P = 0.029, respectively). In patients with low scores, there was no difference in 1°EP between IMs/PMs vs. RMs/NMs; however, an interaction was observed between acute and chronic coronary syndromes for both low CHADS‐P 2 A 2 RC (HR adj : 2.12; 95% CI: 1.11–4.03 and HR adj : 0.68; 95% CI: 0.34–1.36; P interaction = 0.017) and TRS 2°P scores (HR adj : 2.34; 95% CI: 1.07–5.12 and HR adj : 0.52; 95% CI: 0.22–1.17; P interaction = 0.008). Among clopidogrel‐treated patients, the carriage of the CYP2C19 LoF allele was associated with higher ischemic risk, particularly in those with high clinical risk or an acute coronary syndrome presentation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".