切换抗血小板治疗对不同CYP2C19表型急性冠脉综合征患者的影响:来自单中心研究的见解

IF 1.7 3区 医学 Q4 BIOTECHNOLOGY & APPLIED MICROBIOLOGY
Pharmacogenetics and genomics Pub Date : 2025-07-01 Epub Date: 2025-03-21 DOI:10.1097/FPC.0000000000000564
Nagendra Boopathy Senguttuvan, Muralidharan Thoddi Ramamurthy, Nithesh Kumar, Pavitraa Saravana Kumar, Yogapriya Chidambaram, Madhesh Kasi, Gautam Ganesan Karthikeyan, Asuwin Anandaram, Bharath Raj Kidambi, Sadhanandham Shanmugasundram, Manokar Panchanatham, Rammurthy Anjanappa, Venu Seenappa, Vettriselvi Venkatesan, Ramesh Sankaran, Thanikachalam Sadagopan
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引用次数: 0

摘要

目的:优化抗血小板治疗是急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗(pci)的关键。本研究旨在评估CYP2C19功能丧失(LOF)变异的患病率,并评估替格瑞洛、氯吡格雷和阿司匹林在ACS-PCI患者中的临床结果。方法:本研究包括来自印度南部(主要是泰米尔纳德邦)的冠状动脉疾病和PCI患者。根据他们的CYP2C19 LOF变体进行分类。患者进一步分为1组(继续使用替格瑞洛)和2组(改用氯吡格雷),随访40个月。评估主要和次要结局。结果:共287例患者进行基因分型,其中正常36.2%,中间46.3%,代谢不良17.5%,优势等位基因为CYP2C19*2。在只考虑接受PCI和替格瑞洛治疗的患者后,招募了111名患者。45.9%的患者将替格瑞洛转为氯吡格雷。不同代谢物组和替格瑞洛转氯吡格雷患者的主要不良心血管事件或个体结局无统计学差异。中间代谢物(IMs)表现出有利于替格瑞洛延续的趋势。值得注意的是,在仅使用氯吡格雷的组中,IM患者停用阿司匹林与靶血管再干预(TVR)增加有关。结论:我们的研究提供了初步证据,支持替格瑞洛继续治疗,并增加了IM患者停药后的TVR。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Impact of switching antiplatelet therapy in acute coronary syndrome patients with different CYP2C19 phenotypes: insights from a single-center study.

Objective: Optimizing antiplatelet therapy is crucial in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary interventions (PCIs). This study aimed to assess the prevalence of CYP2C19 loss-of-function (LOF) variants and evaluate the clinical outcome of ticagrelor, clopidogrel, and aspirin in patients with ACS-PCI.

Methods: This study included patients from the southern part of India (predominantly Tamil Nadu) with coronary artery disease and PCI. They were categorized based on their CYP2C19 LOF variants. Patients were further divided into group 1 (continued ticagrelor) and group 2 (switched to clopidogrel) and followed up for 40 months. The primary and secondary outcomes were evaluated.

Results: A total of 287 patients were genotyped, 36.2% were normal, 46.3% were intermediate, and 17.5% were poor metabolizers, the predominant allele being CYP2C19 *2. After considering only patients who underwent PCI and received ticagrelor, 111 patients were recruited. Ticagrelor was switched to clopidogrel in 45.9% of patients. No statistically significant differences in major adverse cardiovascular events or individual outcomes were observed among different metabolizer groups and patients switched from ticagrelor to clopidogrel. Intermediate metabolizers (IMs) exhibited a trend favoring ticagrelor continuation. Notably, discontinuation of aspirin in IM was linked to increased target vessel reintervention (TVR) in the clopidogrel-only group.

Conclusion: Our study provides preliminary evidence on favoring ticagrelor continuation and increased TVR upon aspirin withdrawal in IM.

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来源期刊
Pharmacogenetics and genomics
Pharmacogenetics and genomics 医学-生物工程与应用微生物
CiteScore
3.20
自引率
3.80%
发文量
47
审稿时长
3 months
期刊介绍: ​​​​Pharmacogenetics and Genomics is devoted to the rapid publication of research papers, brief review articles and short communications on genetic determinants in response to drugs and other chemicals in humans and animals. The Journal brings together papers from the entire spectrum of biomedical research and science, including biochemistry, bioinformatics, clinical pharmacology, clinical pharmacy, epidemiology, genetics, genomics, molecular biology, pharmacology, pharmaceutical sciences, and toxicology. Under a single cover, the Journal provides a forum for all aspects of the genetics and genomics of host response to exogenous chemicals: from the gene to the clinic.
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