Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
Department of Cardiology, 12th ward, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Disease, Beijing Key Laboratory of Precision Medicine of Coronary Atherosclerotic Disease, Clinical Center for Coronary Heart Disease, Capital Medical University, Beijing, China.
Cardiovasc Drugs Ther. 2020 Apr;34(2):179-188. doi: 10.1007/s10557-020-06956-4.
To compare the risk of cardiovascular events between patients with two CYP2C19 loss-of-function alleles who were prescribed ticagrelor or clopidogrel after percutaneous coronary intervention (PCI).
Patients with two loss-of-function alleles based on the CYP2C19 genotype were selected from patients enrolled in a retrospective institutional registry. Propensity score matching using logistic regression was performed to adjust for bias between patients prescribed ticagrelor or clopidogrel. Multivariate Cox regression was used to compare the risk of adverse events in the ticagrelor and clopidogrel groups. The primary outcome was the incidence of major adverse cardiac events plus any repeat target vessel revascularization within 12 months after PCI. The safety outcomes were minor and major bleeding events.
From 1518 patients carrying two loss-of-function alleles based on the CYP2C19 genotype who underwent PCI, 638 patients treated with ticagrelor or clopidogrel were successfully propensity-score matched. The primary outcome occurred in 25 patients (7.8%) in the ticagrelor group and 47 (14.7%) in the clopidogrel group. The risk of the primary outcome was significantly lower in the ticagrelor group versus the clopidogrel group (HR 0.466, 95% CI 0.286-0.759, p = 0.002). The incidence of major bleeding events did not significantly differ between the ticagrelor and clopidogrel groups (0.3% and 0.9%, respectively), while the ticagrelor group had a higher risk of minor bleeding events (HR 1.959, 95% CI 1.396-2.750, p < 0.001).
In patients with two CYP2C19 loss-of-function alleles, ticagrelor was more effective than clopidogrel in preventing cardiovascular events, while the two antiplatelet agents were associated with similar incidences of major bleeding.
比较经皮冠状动脉介入治疗（PCI）后携带两个 CYP2C19 失活等位基因的患者使用替格瑞洛或氯吡格雷的心血管事件风险。
从参加回顾性机构注册的患者中选择基于 CYP2C19 基因型携带两个失活等位基因的患者。使用逻辑回归进行倾向评分匹配，以调整替格瑞洛和氯吡格雷组患者之间的偏倚。使用多变量 Cox 回归比较替格瑞洛组和氯吡格雷组的不良事件风险。主要结局为 PCI 后 12 个月内主要不良心脏事件加任何重复靶血管血运重建的发生率。安全性结局为轻微和主要出血事件。
在 1518 例基于 CYP2C19 基因型携带两个失活等位基因行 PCI 的患者中，638 例接受替格瑞洛或氯吡格雷治疗的患者成功进行了倾向评分匹配。替格瑞洛组 25 例（7.8%）和氯吡格雷组 47 例（14.7%）发生主要结局。替格瑞洛组的主要结局风险显著低于氯吡格雷组（HR 0.466，95%CI 0.286-0.759，p=0.002）。替格瑞洛组和氯吡格雷组主要出血事件发生率无显著差异（分别为 0.3%和 0.9%），但替格瑞洛组轻微出血事件风险较高（HR 1.959，95%CI 1.396-2.750，p<0.001）。
在携带两个 CYP2C19 失活等位基因的患者中，替格瑞洛预防心血管事件的效果优于氯吡格雷，而两种抗血小板药物的主要出血发生率相似。
