Ticagrelor Versus Clopidogrel in Patients with Two CYP2C19 Loss-of-Function Alleles Undergoing Percutaneous Coronary Intervention
Ticagrelor Versus Clopidogrel in Patients with Two CYP2C19 Loss-of-Function Alleles Undergoing Percutaneous Coronary Intervention
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DOI：
10.1007/s10557-020-06956-4
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发表时间：
2020-03
影响因子：
3.4
通讯作者：
Z. Xi;Yu-jie Zhou;Ying-xin Zhao;Xiaoli Liu;Jing Liang;M. Chai;Ying Yu;Wei Liu
中科院分区：
文献类型：
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作者：
Z. Xi;Yu-jie Zhou;Ying-xin Zhao;Xiaoli Liu;Jing Liang;M. Chai;Ying Yu;Wei Liu
目的比较具有两个CYP 2C 19功能丧失等位基因的患者在经皮冠状动脉介入治疗（PCI）后服用替格瑞洛或氯吡格雷的心血管事件风险。方法基于CYP 2C 19基因型，具有两个功能丧失等位基因的患者从回顾性机构登记处招募的患者中选出。使用逻辑回归进行倾向评分匹配，以调整替格瑞洛或氯吡格雷处方患者之间的偏倚。多变量考克斯回归用于比较替格瑞洛和氯吡格雷组中不良事件的风险。主要结局是PCI后12个月内主要不良心脏事件的发生率以及任何重复靶血管血运重建。的安全性结果是轻微和严重的出血events.ResultsFrom 1518例携带两个功能丧失等位基因的基础上的CYP 2C 19基因型谁接受PCI，638例替格瑞洛或氯吡格雷治疗的患者成功的倾向评分匹配。替格瑞洛组25例（7.8%）患者和氯吡格雷组47例（14.7%）患者发生主要结局。替格瑞洛组的主要结局风险显著低于氯吡格雷组（HR 0.466，95%CI 0.286- 0.759，p = 0.002）。替卡格雷组和氯吡格雷组之间大出血事件的发生率没有显着差异（分别为0.3%和0.9%），而替格瑞洛组发生轻微出血事件的风险更高（HR 1.959，95%CI 1.396- 2.750，p < 0.001）结论在携带两个CYP 2C 19功能丧失等位基因的患者中，替格瑞洛在预防心血管事件方面比氯吡格雷更有效，而这两种抗血小板药物的大出血发生率相似。
PurposeTo compare the risk of cardiovascular events between patients with two CYP2C19 loss-of-function alleles who were prescribed ticagrelor or clopidogrel after percutaneous coronary intervention (PCI).MethodsPatients with two loss-of-function alleles based on the CYP2C19 genotype were selected from patients enrolled in a retrospective institutional registry. Propensity score matching using logistic regression was performed to adjust for bias between patients prescribed ticagrelor or clopidogrel. Multivariate Cox regression was used to compare the risk of adverse events in the ticagrelor and clopidogrel groups. The primary outcome was the incidence of major adverse cardiac events plus any repeat target vessel revascularization within 12 months after PCI. The safety outcomes were minor and major bleeding events.ResultsFrom 1518 patients carrying two loss-of-function alleles based on the CYP2C19 genotype who underwent PCI, 638 patients treated with ticagrelor or clopidogrel were successfully propensity-score matched. The primary outcome occurred in 25 patients (7.8%) in the ticagrelor group and 47 (14.7%) in the clopidogrel group. The risk of the primary outcome was significantly lower in the ticagrelor group versus the clopidogrel group (HR 0.466, 95% CI 0.286–0.759,p= 0.002). The incidence of major bleeding events did not significantly differ between the ticagrelor and clopidogrel groups (0.3% and 0.9%, respectively), while the ticagrelor group had a higher risk of minor bleeding events (HR 1.959, 95% CI 1.396–2.750,p< 0.001).ConclusionsIn patients with two CYP2C19 loss-of-function alleles, ticagrelor was more effective than clopidogrel in preventing cardiovascular events, while the two antiplatelet agents were associated with similar incidences of major bleeding.