Shi Xiujin, Zhang Yunnan, Zhang Yi, Zhang Ru, Lin Baidi, Han Jialun, Li Wenzheng, Fang Zhenwei, Yan Jialin, Wang Yifan, Zheng Ze, Lv Yuan, Lin Yang
Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
School of Pharmaceutical Sciences, Capital Medical University, Beijing, China.
Front Cardiovasc Med. 2021 Jun 16;8:676954. doi: 10.3389/fcvm.2021.676954. eCollection 2021.
The clinical benefits of cytochrome P450 (CYP) 2C19 genotype-guided antiplatelet therapy in Asians remain unclear. In this study, we aimed to investigate the clinical outcomes of pharmacogenomic antiplatelet therapy in Chinese patients. Patients with acute coronary syndrome planning to undergo percutaneous coronary intervention were eligible for this study and were randomly divided into a genotype-guided treatment (GT) group and routine treatment (RT) group, with a ratio of 2:1. Patients in the GT group underwent CYP2C19 genotyping (2 and 3 alleles), and the results were considered in selecting P2Y receptor inhibitors. Patients in the RT group were treated with P2Y receptor inhibitors according to their clinical characteristics. The primary endpoint was a composite of major adverse cardiovascular or cerebrovascular events (MACCE). The secondary endpoint was significant bleeding events. Finally, 301 patients were enrolled; 75.1% were men and the mean age was 59.7 ± 9.8 years. In total, 281 patients completed the follow-up procedure. The primary endpoint occurred in 16 patients, 6 patients in the GT group and 10 in the RT group. The GT group showed lower MACCE rates than the RT group (6/189 vs. 10/92, 3.2 vs. 10.9%, hazard ratio: 0.281, 95% confidence interval: 0.102-0.773, = 0.009). There was no statistically difference in significant bleeding events between the GT and RT groups (4.2 vs. 3.3%, hazard ratio: 1.315, 95% confidence interval: 0.349-4.956, = 0.685). Personalized antiplatelet therapy that is based on CYP2C19 genotypes could decrease MACCE within a 12-month period in Chinese patients with acute coronary syndrome undergoing percutaneous coronary intervention. http://www.chictr.org.cn, identifier: ChiCTR2000034352.
细胞色素P450（CYP）2C19基因分型指导的抗血小板治疗对亚洲人的临床益处仍不明确。在本研究中，我们旨在调查中国患者中药物基因组学抗血小板治疗的临床结局。计划接受经皮冠状动脉介入治疗的急性冠状动脉综合征患者符合本研究条件，并按2:1的比例随机分为基因分型指导治疗（GT）组和常规治疗（RT）组。GT组患者进行CYP2C19基因分型（2和3等位基因），并在选择P2Y受体抑制剂时考虑结果。RT组患者根据其临床特征接受P2Y受体抑制剂治疗。主要终点是主要不良心血管或脑血管事件（MACCE）的复合终点。次要终点是严重出血事件。最后，共纳入301例患者；75.1%为男性，平均年龄为59.7±9.8岁。共有281例患者完成了随访程序。主要终点事件发生在16例患者中，GT组6例，RT组10例。GT组的MACCE发生率低于RT组（6/189 vs. 10/92，3.2% vs. 10.9%，风险比：0.281，95%置信区间：0.102 - 0.773，P = 0.009）。GT组和RT组之间严重出血事件无统计学差异（4.2% vs. 3.3%，风险比：1.315，95%置信区间：0.349 - 4.956，P = 0.685）。基于CYP2C19基因分型的个性化抗血小板治疗可在12个月内降低接受经皮冠状动脉介入治疗的中国急性冠状动脉综合征患者的MACCE。http://www.chictr.org.cn，标识符：ChiCTR2000034352
