Sri Ramachandra Institute Higher Education & Research (SRIHER), Porur, Chennai, 600116, India.
Sree Balaji Medical College Hospital, Chromepet, Chennai, 600044, India.
Indian Heart J. 2020 Nov-Dec;72(6):589-592. doi: 10.1016/j.ihj.2020.09.002. Epub 2020 Sep 9.
To estimate the incidence of major adverse cardiovascular events (MACE) with genotype test-guided antiplatelet therapy in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome.
Patients who had undergone PCI for acute coronary syndrome as well as stable coronary artery disease were recruited. Salivary samples were obtained from these patients and genotyped for CYP2C19∗2, CYP2C19∗3 variations by sequencing method (GAAP x method). Patients were categorized as normal (GG, GG) (29%), intermediate (AG) (52%) or poor metabolizes (homozygous variant AA) (19%). Dual antiplatelets were given based on the genotyping data. Poor metabolizes received newer agent (ticagrelor), intermediate metabolizes received double-dose of clopidogrel and normal metabolizes received therapeutic doses of clopidogrel. All subjects were followed-up for six months.
Based on the genotyping data of CYP2C19∗2 and CYP2C19∗3 variations, it was found that most patients were categorized as 'intermediate' (78, 51.65%), followed by 'normal' (43, 28.48%) and 'poor' metabolizes (30, 19.87%). Only 3 (1.5%) of 151 patients reported MACE at follow-up.
Genotyping for CYP2C19 variations to assess clopidogrel resistance in patients undergoing PCI and subsequent drug selection helps reduce MACE after coronary intervention.
评估经皮冠状动脉介入治疗（PCI）治疗急性冠状动脉综合征患者中基因检测指导的抗血小板治疗与主要不良心血管事件（MACE）的相关性。
招募了因急性冠状动脉综合征和稳定型冠状动脉疾病而行 PCI 的患者。从这些患者中采集唾液样本，并通过测序方法（GAAP x 方法）对 CYP2C19∗2、CYP2C19∗3 变异进行基因分型。患者被分为正常代谢型（GG、GG）（29%）、中间代谢型（AG）（52%）或弱代谢型（纯合变异 AA）（19%）。根据基因分型数据给予双联抗血小板治疗。弱代谢型患者接受新型药物（替格瑞洛），中间代谢型患者接受氯吡格雷双倍剂量，正常代谢型患者接受氯吡格雷治疗剂量。所有患者均随访 6 个月。
根据 CYP2C19∗2 和 CYP2C19∗3 变异的基因分型数据，发现大多数患者被归类为“中间代谢型”（78 例，51.65%），其次是“正常代谢型”（43 例，28.48%）和“弱代谢型”（30 例，19.87%）。在随访期间，仅 151 例患者中的 3 例（1.5%）报告发生 MACE。
对行 PCI 的患者进行 CYP2C19 变异基因检测以评估氯吡格雷抵抗，并进行后续药物选择，有助于降低冠状动脉介入治疗后的 MACE。
