Zheng Xiaofang, Wu Liming
Department of Cardiology, The Third Affiliated Hospital of Fujian Medical University, Fuzhou 350108, China.
Department of Cardiology, Union Hospital affiliated to Fujian Medical University, Fuzhou 350001, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2020 Feb 29;40(2):274-278. doi: 10.12122/j.issn.1673-4254.2020.02.21.
To evaluate the efficacy and safety of different antiplatelet therapies for stable angina patients with complicated left main coronary artery lesions and intermediate metabolizer Cytochrome P450 2C19 gene (CYP2C19) undergoing PCI.
A total of 247 patients diagnosed with stable angina in cardiology department of Fujian union hospital from February 2015 to February 2017 were retrospectively analyzed, among them, the elective PCI were performed on the left main coronary artery and the CYP2C19 gene poly-morphism were intermediate metabolize, they were divided into ticagrelor treatment group(aspirin combined with ticagrelor, =95)and clopidogrel treatment group(aspirin combined with clopidogrel, =152) according to the different antiplatelet treatment programs. Both groups were given aspirin 300 mg and clopidogrel 300 mg orally before PCI; the ticagrelor group were given the maintenance dose of ticagrelor (90 mg orally, twice a day) after PCI, while those in clopidogrel group were clopidogrel 75 mg orally (once a day) after PCI; both groups were given the maintenance dose of aspirin (100 mg orally, once a day)after PCI. The major adverse cardiovascular events (MACE) were observed within 12 months after PCI.
At 12 months after PCI, the incidence of MACE in the ticagrelor treatment group was significantly lower than that in the clopidogrel treatment group, the difference was statistically significant (2.1% 15.1%, =0.001).There were no significant differences between the two groups in the restenosis rates of non- revascularized target vessel, recurrent rates of angina pectoris(but not myocardial infarction), recurrent rates of myocardial infarction, and revascularization rates of target vessel ( > 0.05). There were also no significant differences between the two groups in bleeding.
For stable angina patients with complicated left main coronary artery lesions and intermediate metabolizer CYP2C19 gene, aspirin combined with ticagrelor antiplatelet therapy after PCI is effective, the effect of ticagrelor is better than clopidogrel on MACE, and ticagrelor does not seem to increase the risk of bleeding.
评估不同抗血小板治疗方案对伴有复杂左主干冠状动脉病变且细胞色素P450 2C19基因（CYP2C19）为中间代谢型的稳定型心绞痛患者行冠状动脉介入治疗（PCI）的有效性和安全性。
回顾性分析2015年2月至2017年2月在福建医科大学附属协和医院心内科确诊为稳定型心绞痛的247例患者，其中对左主干冠状动脉进行择期PCI且CYP2C19基因多态性为中间代谢型的患者，根据不同抗血小板治疗方案分为替格瑞洛治疗组（阿司匹林联合替格瑞洛，n = 95）和氯吡格雷治疗组（阿司匹林联合氯吡格雷，n = 152）。两组患者在PCI术前均口服阿司匹林300 mg和氯吡格雷300 mg；替格瑞洛组在PCI术后给予替格瑞洛维持剂量（口服90 mg，每日2次），而氯吡格雷组在PCI术后口服氯吡格雷75 mg（每日1次）；两组患者在PCI术后均给予阿司匹林维持剂量（口服100 mg，每日1次）。观察PCI术后12个月内的主要不良心血管事件（MACE）。
PCI术后12个月，替格瑞洛治疗组MACE发生率显著低于氯吡格雷治疗组，差异有统计学意义（2.1% 对15.1%，P = 0.001）。两组在未行血运重建的靶血管再狭窄率、心绞痛复发率（但非心肌梗死）、心肌梗死复发率及靶血管血运重建率方面差异均无统计学意义（P > 0.05）。两组在出血方面差异也无统计学意义。
对于伴有复杂左主干冠状动脉病变且CYP2C19基因为中间代谢型的稳定型心绞痛患者，PCI术后阿司匹林联合替格瑞洛抗血小板治疗有效，替格瑞洛在预防MACE方面效果优于氯吡格雷，且替格瑞洛似乎未增加出血风险。
