Personalized antiplatelet therapy according to CYP2C19 genotype after percutaneous coronary intervention: A randomized control trial
Personalized antiplatelet therapy according to CYP2C19 genotype after percutaneous coronary intervention: A randomized control trial
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经皮冠状动脉介入治疗后根据CYP2C19基因型的个体化抗血小板治疗：随机对照试验
DOI：
10.1016/j.ijcard.2013.06.014
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发表时间：
2013-10-09
影响因子：
3.5
通讯作者：
Baituola, Gulinaer
中科院分区：
文献类型：
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作者：
Xie, Xiang;Ma, Yi-Tong;Baituola, Gulinaer
目的：比较经皮冠状动脉介入治疗（PCI）后患者根据CYP2C19表型进行个体化抗血小板治疗与常规抗血小板治疗的效果。方法：600例行PCI的冠心病（CAD）患者随机接受个体化抗血小板治疗（A组301例）或常规抗血小板治疗（B组299例）。A组根据CYP2C19表型进行抗血小板治疗。B组患者接受常规抗血小板治疗，未检测CYP2C19基因型。比较两组的主要终点。本研究已在中国临床试验注册中心注册（ChiCTR-TRC-11001807）。结果：主要终点发生在27例接受常规治疗的患者中，而8例接受个性化治疗的患者中（累积事件发生率，9.03% vs. 2.66%; P < 0.01）。两组患者180天死亡、心肌梗死、脑卒中的综合发生率分别为3例和18例（累积事件发生率分别为1.0%和6.2%,P < 0.01）。A组累计180天ST发生率明显低于B组（0.66% vs. 3.01%, P - 0.032）。180天心肌梗死发生率（0.33% vs. 3.01%, P = 0.011）和死亡发生率（0.33% vs. 2.34%, P = 0.011）均低于对照组。我们没有发现两组之间出血事件的显著差异。结论：PCI术后根据CYP2C19基因型进行个体化抗血小板治疗可显著降低中国人群主要心血管不良事件发生率和180天ST发生风险。2013爱思唯尔爱尔兰有限公司版权所有。
Objective: The objective of this study is to compare personalized antiplatelet therapy according to CYP2C19 phenotype with conventional antiplatelet therapy in patients after percutaneous coronary intervention (PCI).Methods: A total of 600 patients with coronary artery disease (CAD) undergoing PCI randomly received a personalized antiplatelet therapy (group A; n = 301) or conventional antiplatelet treatment (group B; n = 299). For group A, antiplatelet therapy was performed according to CYP2C19 phenotype. For group B, the patients received conventional antiplatelet treatment without detected CYP2C19 genotype. The primary end point was compared between these two groups. This study is registered with the Chinese Clinical Trial Registry (ChiCTR-TRC-11001807).Results: The primary end point occurred in 27 patients assigned to conventional treatment as compared with 8 patients assigned to personalized therapy (cumulative event rate, 9.03% vs. 2.66%; P < 0.01). The composite rate of death, myocardial infarction, or stroke at 180 days occurred in 3 and 18 patients in the two groups, respectively (cumulative event rate, 1.0% and 6.2%, P < 0.01). The cumulative 180-day incidence of ST was significantly lower in group A than in group B (0.66% vs. 3.01%, P - 0.032). The 180-day incidence of MI (0.33% vs. 3.01%, P = 0.011) and death (0.33% vs. 2.34%, P = 0.011) was fewer than that in control, respectively. We did not find the significant difference in bleeding events between the 2 groups.Conclusion: Personalized antiplatelet therapy according to CYP2C19 genotype after PCI can significantly decrease the incidence of major adverse cardiovascular events and the risk of 180-day ST in Chinese population. (C) 2013 Elsevier Ireland Ltd. All rights reserved.