Development and Validation of a Novel Tool for the Prediction of Clopidogrel Response in Chinese Acute Coronary Syndrome Patients: The GeneFA Score.
Development and Validation of a Novel Tool for the Prediction of Clopidogrel Response in Chinese Acute Coronary Syndrome Patients: The GeneFA Score.
复制标题
DOI：
10.3389/fphar.2022.854867
复制
发表时间：
2022
影响因子：
5.6
通讯作者：
Ge J
中科院分区：
文献类型：
--
作者：
Wu H;Li X;Qian J;Zhao X;Yao Y;Lv Q;Ge J
目的：越来越多的证据表明，CYP2C19 基因型只能解释氯吡格雷药效反应的一小部分，而许多临床因素也有一定的影响。我们的目标是开发一种新的风险评分，以改善接受氯吡格雷治疗的中国患者缺血事件的预后。 方法：制定了新的风险评分，并在 445 名接受冠状动脉支架置入术的急性冠脉综合征 (ACS) 患者中进行了内部验证。最终评分被命名为 GeneFA 评分，其中包含 CYP2C19 基因型、纤维蛋白原和年龄。 GeneFA 评分的外部验证以及与 ABCD-GENE 评分的比较是在独立的 ACS 队列中进行的。 结果：根据观察到的与 GeneFA 风险评分相关的高血小板反应性 (HRPR) 频率，在上五分位数中观察到相对较高的临床 HRPR，代表性评分为 3 (52.90%) 和 4 (59.10%)，而在评分为 0 (6.70%)、1 (15.10%) 和 2 (16.70%) 的组中出现频率较低。 GeneFA 评分 >2 的参与者 HRPR（54.3 vs. 14.7%，p < 0.001）和缺血复发（20.7 vs. 5.4%，p < 0.001）的风险增加。与 ABCD-GENE 评分相比，GeneFA 评分对高 HRPR 患者表现出更好的预测 (p < 0.001)。在验证人群中，GeneFA 表明，与 ABCD-GENE 相比，氯吡格雷在 HRPR 发生率（C 统计量：GeneFA 为 0.855，ABCD-GENE 为 0.843）和缺血性复发（C 统计量：GeneFA 为 0.726，ABCD-GENE 为 0.724）方面具有相似的高预后价值。 结论：GeneFA 风险评分对中国人群 CAD 患者氯吡格雷 HRPR 具有中等预测能力。 GeneFA评分的预测价值与HRPR鉴定的ABCD-GENE评分一致。
Aim: Growing evidence indicated that CYP2C19 genotypes could only explain a fraction of the pharmacodynamic response to clopidogrel, while a number of clinical factors also have contributing roles. Our objective was to develop a new risk score to improve prognostication of ischemic events in Chinese patients treated with clopidogrel. Methods: A new risk score was developed and internally validated in 445 patients with acute coronary syndrome (ACS) undergoing coronary stenting. The final score was named the GeneFA score based on the inclusion of CYP2C19 genotype, fibrinogen, and age. External validation of the GeneFA score and comparison with the ABCD-GENE score were performed in an independent ACS cohort. Results: Based on the observed frequencies of high platelet reactivity (HRPR) in relation to the GeneFA risk score, a relatively higher clinical HRPR was observed in the upper quintile with a representative score of 3 (52.90%) and 4 (59.10%), whereas it was found less frequently in groups with scores 0 (6.70%), 1 (15.10%), and 2 (16.70%). Participants with a GeneFA score >2 had an increased risk of HRPR (54.3 vs. 14.7%, p < 0.001) and ischemic recurrence (20.7 vs. 5.4%, p < 0.001). The GeneFA score exhibited a better prediction for high HRPR patients as compared to the ABCD-GENE score (p < 0.001). In the validation population, GeneFA illustrated a similarly high prognostic value for HRPR incidence (C-statistic: 0.855 for GeneFA and 0.843 for ABCD-GENE) and ischemic recurrence (C-statistic: 0.726 for GeneFA and 0.724 for ABCD-GENE) on clopidogrel as compared to ABCD-GENE. Conclusion: The GeneFA risk score had a moderate predictive ability for HRPR on clopidogrel for CAD patients in Chinese populations. The predictive value of the GeneFA score was consistent with the ABCD-GENE score for HRPR identification.
登录
查看更多内容
影响因子：
4.5
作者：
Jiang XL;Samant S;Lesko LJ;Schmidt S
通讯作者：
Schmidt S
影响因子：
7.5
作者：
Griffiths TM;Page L;Weyrich AS;Rondina MT;Campbell RA
通讯作者：
Campbell RA
影响因子：
20.1
作者：
North BJ;Sinclair DA
通讯作者：
Sinclair DA
影响因子：
11.3
作者：
Angiolillo, Dominick J.;Capodanno, Davide;Price, Matthew J.
通讯作者：
Price, Matthew J.
影响因子：
8.2
作者：
Wu, Hong-yi;Zhang, Chi;Ge, Jun-bo
通讯作者：
Ge, Jun-bo