Sánchez-Ramos Jesús, Dávila-Fajardo Cristina Lucía, Toledo Frías Pablo, Díaz Villamarín Xando, Martínez-González Luis Javier, Martínez Huertas Susana, Burillo Gómez Francisco, Caballero Borrego Juan, Bautista Pavés Alicia, Marín Guzmán Mª Carmen, Ramirez Hernández José Antonio, Correa Vilches Concepción, Cabeza Barrera Jose
Department of Cardiology, Granada University Hospital, Institute for biomedical research, ibs.GRANADA, Spain.
Department of Clinical Pharmacy, Granada University Hospital, Institute for biomedical research, ibs.GRANADA, Spain.
Int J Cardiol. 2016 Dec 15;225:289-295. doi: 10.1016/j.ijcard.2016.09.088. Epub 2016 Sep 26.
Clopidogrel has provided beneficial effects in acute coronary syndrome and percutaneous coronary intervention. Different polymorphisms have been associated with differences in clopidogrel response. The aim of this study was to check if CYP2C19/ABCB1-genotype-guided strategy reduces the rates of cardiovascular events and bleeding.
This experimental study included patients undergoing percutaneous coronary intervention with stent. The prospective genotype-guided strategy (intervention group) was compared against a retrospective non-tailored strategy (control group). Primary efficacy endpoint was the composite of cardiovascular death, acute coronary syndrome or stroke during 12months after intervention. Secondary endpoint was to compare the efficacy of the different antiplatelet therapies used in genotyping conditions.
The study included 719 patients undergone stent, more than 86% with acute coronary syndrome. The primary endpoint occurred in 32 patients (10.1%) in the genotyping group and in 59 patients (14.1%) in the control group (HR 0.63, 95% CI (0.41-0.97), p =0.037). There was no difference in The Thrombolysis in Myocardial Infarction major and minor bleeding criteria between the two groups (4.1% vs. 4.7%, HR=0.80, 95% CI (0.39-1.63), p=0.55). In intervention group, there was no difference in the rate of events in patients treated with clopidogrel versus patients treated with other antiplatelet treatments (9.1% vs 11.5% p=0.44), or bleeding (3.7% vs 4.6%, p=0.69).
The genotype-guided strategy could reduce the rates of composite of cardiovascular events and bleeding during 12months after percutaneous coronary intervention compared to a non-genotype-guide strategy.
氯吡格雷在急性冠脉综合征和经皮冠状动脉介入治疗中具有有益作用。不同的基因多态性与氯吡格雷反应的差异有关。本研究的目的是检验CYP2C19/ABCB1基因分型指导策略是否能降低心血管事件和出血的发生率。
本实验研究纳入了接受支架置入术的经皮冠状动脉介入治疗患者。将前瞻性基因分型指导策略（干预组）与回顾性非个体化策略（对照组）进行比较。主要疗效终点是干预后12个月内心血管死亡、急性冠脉综合征或卒中的复合终点。次要终点是比较基因分型情况下使用的不同抗血小板治疗的疗效。
该研究纳入了719例行支架置入术的患者，超过86%患有急性冠脉综合征。基因分型组有32例患者（10.1%）发生主要终点事件，对照组有59例患者（14.1%）发生主要终点事件（风险比0.63，95%置信区间(0.41 - 0.97)，p = 0.037）。两组在心肌梗死溶栓治疗的主要和次要出血标准方面无差异（4.1%对4.7%，风险比=0.80，95%置信区间(0.39 - 1.63)，p = 0.55）。在干预组中，接受氯吡格雷治疗的患者与接受其他抗血小板治疗的患者在事件发生率（9.1%对11.5%，p = 0.44）或出血发生率（3.7%对4.6%，p = 0.69）方面无差异。
与非基因分型指导策略相比，基因分型指导策略可降低经皮冠状动脉介入治疗后12个月内心血管事件和出血的复合发生率。
