Department of Emergency and Chest Pain Center, Cheeloo College of Medicine, Qilu Hospital of Shandong University.
Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University, Cheeloo College of Medicine, Qilu Hospital of Shandong University.
Int Heart J. 2021 Jan 30;62(1):171-174. doi: 10.1536/ihj.20-309. Epub 2021 Jan 16.
A 41-year-old woman with chest pain for 6 hours was admitted to our chest pain center, presenting with acute myocardial infarction. Coronary angiography showed acute total occlusion in the proximal left anterior descending artery due to late stent thrombosis. After thrombus aspiration and intracoronary administration of 0.5 mg tirofiban, repeated angiography showed that no obvious residual stenosis remained. The patient underwent drug-coated balloon angioplasty 69 days ago and was then administered dual antiplatelet treatment (aspirin and clopidogrel) uninterruptedly. Genetic testing found that both cytochrome P450 2C19 (CYP2C19) (G681A) and glycoprotein Ia (GPIa) (C807T, G873A) were hybrid mutant types, demonstrating that the patient was possibly resistant to clopidogrel and aspirin simultaneously. Thus, clopidogrel was replaced by ticagrelor and no more cardiovascular adverse events occurred during the 2-year follow-up.
一位 41 岁女性因胸痛 6 小时入住我院胸痛中心，诊断为急性心肌梗死。冠状动脉造影显示左前降支近段急性完全闭塞，考虑为晚期支架内血栓形成。血栓抽吸及替罗非班 0.5mg 冠状动脉内给药后，重复造影显示无明显残余狭窄。患者 69 天前接受药物涂层球囊血管成形术治疗，随后不间断地进行双联抗血小板治疗（阿司匹林和氯吡格雷）。基因检测发现细胞色素 P450 2C19（CYP2C19）（G681A）和糖蛋白 Ia（GPIa）（C807T、G873A）均为杂合突变型，提示患者可能同时对氯吡格雷和阿司匹林耐药。因此，将氯吡格雷替换为替格瑞洛，在 2 年的随访期间未再发生心血管不良事件。
