Genetic testing in patients undergoing percutaneous coronary intervention: rationale, evidence and practical recommendations.
Genetic testing in patients undergoing percutaneous coronary intervention: rationale, evidence and practical recommendations.
复制标题
接受经皮冠状动脉介入治疗患者的基因检测：原理、证据和实践建议。
DOI：
10.1080/17512433.2021.1927709
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发表时间：
2021-08
影响因子：
4.4
通讯作者：
Angiolillo, Dominick J.
中科院分区：
文献类型：
--
作者：
Galli, Mattia;Franchi, Francesco;Rollini, Fabiana;Cavallari, Larisa H.;Capodanno, Davide;Crea, Filippo;Angiolillo, Dominick J.
关键词：
氯吡格雷是最常用的P2Y12抑制剂，具有广泛的个体间反应差异，导致相当多患者的血小板抑制受损和血栓并发症风险增加。有效的P2Y12抑制剂普拉格雷和替卡格雷可以克服这一限制，但代价是出血风险增加。细胞色素P450(CYP)2C19酶的遗传变异是氯吡格雷代谢的关键决定因素，它与氯吡格雷的反应谱密切相关，促使人们研究基因引导的抗血小板治疗选择。这篇论文主要关注在接受经皮冠状动脉介入治疗(PCI)的患者中使用基因检测来指导选择血小板P2Y12抑制剂的基本原理。此外，还提供了对现有证据的全面评估和切实可行的建议。实施基因检测作为指导治疗选择的一种策略，可能会导致P2Y12抑制治疗的升级(即改用普拉格雷或替卡格雷)或降级(即改用氯吡格雷)。大多数最近的研究支持在接受经皮冠状动脉介入治疗的患者中选择基因引导的抗血小板治疗的临床益处。将基因检测的结果与临床和程序变量相结合，是一种有希望的策略，可用于选择接受经皮冠状动脉介入治疗的患者的抗血小板治疗。
Clopidogrel is the most frequently utilized P2Y12 inhibitor and is characterized by broad interindividual response variability resulting in impaired platelet inhibition and increased risk of thrombotic complications in a considerable number of patients. The potent P2Y12 inhibitors, prasugrel and ticagrelor, can overcome this limitation but at the expense of an increased risk of bleeding. Genetic variations of the cytochrome P450 (CYP) 2C19 enzyme, a key determinant in clopidogrel metabolism, have been strongly associated with clopidogrel response profiles prompting investigations of genetic-guided selection of antiplatelet therapy. The present manuscript focuses on the rationale for the use of genetic testing to guide the selection of platelet P2Y12 inhibitors among patients undergoing percutaneous coronary intervention (PCI). Moreover, a comprehensive appraisal of the available evidence and practical recommendations are provided. Implementation of genetic testing as a strategy to guide the selection of therapy can result into escalation (i.e., switching to prasugrel or ticagrelor) or de-escalation (i.e., switching to clopidogrel) of P2Y12 inhibiting therapy. Most recent investigations support the clinical benefit of a genetic guided selection of antiplatelet therapy in patients undergo PCI. Integrating the results of genetic testing with clinical and procedural variables represents a promising strategy for a precision medicine approach for the selection of antiplatelet therapy among patients undergoing PCI.
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影响因子：
11.3
作者：
Angiolillo, Dominick J.;Capodanno, Davide;Price, Matthew J.
通讯作者：
Price, Matthew J.
DOI：
10.12659/msm.903054
发表时间：
2017-08-07
期刊：
Medical science monitor : international medical journal of experimental and clinical research
影响因子：
--
作者：
Chen S;Zhang Y;Wang L;Geng Y;Gu J;Hao Q;Wang H;Qi P
通讯作者：
Qi P
影响因子：
37.8
作者：
Angiolillo, Dominick J.;Rollini, Fabiana;Price, Matthew J.
通讯作者：
Price, Matthew J.
影响因子：
158.5
作者：
Collet, Jean-Philippe;Cuisset, Thomas;Montalescot, Gilles
通讯作者：
Montalescot, Gilles
影响因子：
3.9
作者：
El Rouby, Nihal;Alrwisan, Adel;Winterstein, Almut G.
通讯作者：
Winterstein, Almut G.