Department of Cardiac Surgery, Sichuan Provincial People's Hospital Affiliated Hospital of University of Electronic Science and Technology Chengdu China.
Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province Chengdu China.
J Am Heart Assoc. 2024 Aug 20;13(16):e035424. doi: 10.1161/JAHA.124.035424. Epub 2024 Aug 14.
This study aimed to explore the effect of a P2Y inhibitor regimen on the occurrence of postoperative atrial fibrillation (POAF) after off-pump coronary artery bypass graft surgery in carriers with the cytochrome P450 family 2 subfamily C member19 loss-of-function allele.
From May 2019 to November 2023, patients containing the cytochrome P450 family 2 subfamily C member19*2 or *3 allele undergoing elective first-time off-pump coronary artery bypass graft surgery including aspirin 100 mg/d and ticagrelor 180 mg/d (AT group; n=95) versus clopidogrel 75 mg/d (aspirin and clopidogrel group; n=95) were prospectively followed. The primary end point was the cumulative incidence of POAF in a week. The secondary end points were POAF burden, platelet aggregability, systemic immune-inflammation index and heart rate variability. The incidence of POAF was 21.1% in the AT group versus 41.1% in the aspirin and clopidogrel group (hazard ratio, 0.46 [95% CI, 0.27-0.76]; =0.003). POAF burden, ADP-induced platelet aggregation and systemic immune-inflammation index was notably lower in the AT group than the aspirin and clopidogrel group. Heart rate variability data showed an increase in both high-frequency and SD of normal-to-normal RR intervals in the AT group with a decreased low-frequency/high-frequency ratio, suggesting that the sympathetic/parasympathetic activation was balanced.
In patients carrying the cytochrome P450 family 2 subfamily C member19 loss-of-function allele, an AT regimen after off-pump coronary artery bypass grafting was associated with a lower incidence of POAF, paralleled by lower atrial fibrillation burden, ADP-induced platelet aggregation, lower systemic immune-inflammation index reaction, and a balanced automatic nerve system compared with an aspirin and clopidogrel regimen. Inhibiting the systemic immune-inflammation response and sustaining automatic nerve balance may underlie the therapeutic effect of POAF by a potent antiplatelet combination.
本研究旨在探讨在携带细胞色素 P450 家族 2 亚家族 C 成员 19 无功能等位基因的患者中，使用 P2Y 抑制剂方案对非体外循环冠状动脉旁路移植术后心房颤动（POAF）发生的影响。
从 2019 年 5 月至 2023 年 11 月，前瞻性随访了包含细胞色素 P450 家族 2 亚家族 C 成员 192 或3 等位基因的接受择期首次非体外循环冠状动脉旁路移植术的患者，这些患者服用阿司匹林 100mg/d 和替格瑞洛 180mg/d（AT 组；n=95）与氯吡格雷 75mg/d（阿司匹林和氯吡格雷组；n=95）。主要终点为一周内 POAF 的累积发生率。次要终点为 POAF 负荷、血小板聚集率、全身免疫炎症指数和心率变异性。AT 组的 POAF 发生率为 21.1%，而阿司匹林和氯吡格雷组为 41.1%（风险比，0.46 [95% CI，0.27-0.76]；=0.003）。与阿司匹林和氯吡格雷组相比，AT 组的 POAF 负荷、ADP 诱导的血小板聚集和全身免疫炎症指数显著降低。心率变异性数据显示 AT 组的正常-正常 RR 间期高频和 SD 均增加，低频/高频比值降低，提示交感/副交感神经激活平衡。
在携带细胞色素 P450 家族 2 亚家族 C 成员 19 无功能等位基因的患者中，与阿司匹林和氯吡格雷方案相比，非体外循环冠状动脉旁路移植术后使用 AT 方案与 POAF 发生率降低相关，同时 POAF 负荷、ADP 诱导的血小板聚集、全身免疫炎症指数反应降低，自主神经系统平衡。抑制全身免疫炎症反应和维持自主神经平衡可能是强效抗血小板联合治疗 POAF 的治疗效果的基础。
