Evidence map›Paper›PMID 33641235›Full record

Observational studyPharmacology research & perspectives2021

Increase in the risk of clopidogrel resistance and consequent TIMI flow impairment by DNA hypomethylation of CYP2C19 gene in STEMI patients undergoing primary percutaneous coronary intervention (PPCI).

Renan Sukmawan, Erick Hoetama, Siska Suridanda Danny, Astuti Giantini, Erlin Listiyaningsih, Vidya Gilang Rejeki, Amir Aziz Alkatiri, Isman Firdaus

Open access · goldAbstract readObservational Study
In one paragraph

Observational study in Pharmacology research & perspectives, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
1.4field-weighted citation impact, top 18% of its field
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

8 citing papers in PubMed, 1 synthesis or guideline pooled it, 14 citations in OpenAlex.

  1. Frontiers in pharmacology · 2025
    Pooled it
  2. Recent research progress on the mechanisms of clopidogrel resistance.European journal of clinical pharmacology · 2026
    Review
  3. Article
  4. Review
  5. Research and practice in thrombosis and haemostasis · 2023
    Article
  6. Article
  7. Observational
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 1 country.

Renan SukmawanCardiology and Vascular Medicine Department, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
Erick HoetamaCardiology and Vascular Medicine Department, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.ORCID 0000-0002-5742-8986
Siska Suridanda DannyCardiology and Vascular Medicine Department, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
Astuti GiantiniClinical Pathology Department, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National Public Hospital, Jakarta, Indonesia.
Erlin ListiyaningsihIndonesian Cardiovascular Research Center, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
Vidya Gilang RejekiCardiology and Vascular Medicine Department, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
Amir Aziz AlkatiriCardiology and Vascular Medicine Department, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
Isman FirdausCardiology and Vascular Medicine Department, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
Pelita Harapan University · IDNational Brain Centre · IDUniversity of Indonesia · ID

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Clopidogrel resistance is an important risk factor of ischemic event recurrence after optimal antiplatelet therapy. This study aims to investigate the role of CYP2C19 gene DNA methylation as one of the epigenetic factors for the risk of clopidogrel resistance in STEMI patients undergoing PPCI. ST-segment elevation myocardial infarction (STEMI) patients undergoing PPCI were pretreated with clopidogrel, and their platelet function was measured using VerifyNow™ assay. The criteria for high on-treatment platelet reactivity (HPR) were defined according to the expert consensus criteria (PRU >208). DNA methylation of the CYP2C19 gene was performed using bisulfite genomic sequencing technology. Furthermore, clinical, laboratory, and angiographic data including TIMI flow were collected. Among 122 patients, clopidogrel resistance was found in 22%. DNA methylation level percentage was lower in the clopidogrel resistance group (76.7 vs. 88.8, p-value .038). But, the <50% methylation group was associated with increased risk of clopidogrel resistance (OR =4.5, 95%CI =2.1-9.3, p-value = .018). This group was also found to have suboptimal post-PCI TIMI flow (OR =3.4 95%CI =1.3-8.7, p-value =.045). The lower DNA methylation level of the CYP2C19 gene increases the risk of clopidogrel resistance and subsequent poorer clinical outcome.

Indexed as

DNA MethylationAdultClopidogrelCytochrome P-450 CYP2C19Drug ResistanceFemaleHumansMaleMiddle AgedPercutaneous Coronary InterventionPlatelet AggregationRecurrenceSecondary PreventionST Elevation Myocardial InfarctionThrombolytic TherapyClopidogrelCYP2C19 protein, humanCytochrome P-450 CYP2C19acute coronary syndromeclopidogrel resistanceCYP2C19DNA methylation

Identifiers

PMID33641235
PMCPMC7915409
OpenAlexW3133820707

What OpenQuestion holds

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LicenceCC BY
Read underepoch 390

Registered trials

None linked

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 OpenQuestion graph.