Effect of cytochrome P450 2C19(CYP2C19)gene polymor-phism and clopidogrel reactivity on long term prognosis of patients with coronary heart disease after PCI
Cheng-Yan HU1
Yan-Ling WANG2
Zhen-Xing FAN2
Xi-Peng SUN2
Shuai WANG3
Zhi LIU4
1.Department of Geriatrics,Fu Xing Hospital,Capital Medical University,Beijing,China2.Department of Cardiology,Xuanwu Hospital Capital Medical University,Beijing,China3.Department of Cardiology,Xuanwu Hospital Capital Medical University,Beijing,China;Emergency Department of Xuanwu Hospital,Capital Medical University,Beijing,China4.Emergency Department of Xuanwu Hospital,Capital Medical University,Beijing,China
摘要：Objective To investigate the impact of CYP2C19 gene polymorphism on clopidogrel reactivity and its association with long-term clinical outcome in patients with coronary heart disease(CHD)undergoing percutaneous coronary intervention(PCI).
Methods In total,675 patients were enrolled.Based on the platelet inhibition rate,patients were categorized into two groups:clopidogrel low responsiveness(CLR)and normal clopidogrel responsiveness(NCR).The CLR group was divided into ticagrelor and clopidogrel group based on the antiplatelet drugs used in the follow-up treatment.Patients were classified into three groups(normal metabolizer,intermediate metabolizer,and poor metabolizer)based on the CYP2C19 genotype.We aimed to evaluate the impact of CYP2C19 gene polymorphism on clopidogrel reactivity.The cumulative rates of 12-month all-cause deaths,major ad-verse cardiovascular events(MACCEs),and bleeding events were calculated.
Results CLR was observed in 44.4％of the overall population.Significant differences were observed in the platelet inhibition rate of clopidogrel among the three metabolic genotypes(P<0.05).At the 12-month follow-up,13 patients(1.9％)died and 96 pa-tients(14.2％)experienced MACCEs.Patients with CLR(9.6％vs.11.7％vs.22.1％,P<0.05)or poor metabolizer(10.7％vs.16.4％vs.22.6％,P = 0.026)experienced a higher rate of MACCEs.A MACCEs risk score between zero and two was calculated.The highest incidence of MACCEs significantly increased with the 2-positive results,and the area under the curve(AUC)was 0.712(95％CI:0.650-0.774,P<0.05).There was no significant difference between the group with a score of one and the occurrence of MACCEs(P>0.05).
Conclusions Low response to clopidogrel in CHD patients is correlated with CYP2C19 gene polymorphism.CYP2C19 geno-typing combined with platelet reactivity is an independent predictor of 12-months MACCEs in patients with clopidogrel treat-ment after PCI,which is better than either test alone.
机标关键词：prognosislongheartaftergenetermwithclopidogrel
论文发表日期：2024-01-28
在线出版日期：2025-08-15（本平台首次上网日期，不代表文献的发表时间）
页数：14( 90-103 )