Clinical Impact of CYP2C19 Genotype on Clopidogrel-Based Antiplatelet Therapy After Percutaneous Coronary Intervention

被引：20

作者：

Lee, Seung Hun ^{[1
,2
]}

Jeong, Young-Hoon ^{[3
]}

Hong, David ^{[2
]}

Choi, Ki Hong ^{[2
]}

Lee, Joo Myung ^{[2
]}

Park, Taek Kyu ^{[2
]}

Yang, Jeong Hoon ^{[2
]}

Hahn, Joo-Yong ^{[2
]}

Choi, Seung-Hyuck ^{[2
]}

Gwon, Hyeon-Cheol ^{[2
]}

Jeong, Myung Ho ^{[1
]}

Kim, Byeong-Keuk ^{[4
]}

Joo, Hyung Joon ^{[5
]}

Chang, Kiyuk ^{[6
]}

Park, Yongwhi ^{[7
,8
]}

Ahn, Sung Gyun ^{[9
]}

Suh, Jung-Won ^{[10
,11
]}

Lee, Sang Yeub ^{[3
]}

Cho, Jung Rae ^{[12
]}

Her, Ae-Young ^{[13
]}

Kim, Hyo-Soo ^{[14
]}

Kim, Moo Hyun ^{[15
]}

Lim, Do-Sun ^{[5
]}

Shin, Eun-Seok ^{[16
]}

Song, Young Bin ^{[2
]}

机构：

[1] Chonnam Natl Univ Hosp, Chonnam Natl Univ Med Sch, Heart Ctr, Dept Internal Med,Div Cardiol, Gwangju, South Korea

[2] Sungkyunkwan Univ, Heart Vasc Stroke Inst, Samsung Med Ctr, Div Cardiol,Dept Internal Med,Sch Med, 81 Irwon Ro, Seoul 06351, South Korea

[3] Chung Ang Univ, Coll Med, Dept Internal Med, Div Cardiol,Gwangmyeong Hosp, Gwangmyeong, South Korea

[4] Yonsei Univ, Severance Cardiovasc Hosp, Coll Med, Seoul, South Korea

[5] Korea Univ, Korea Univ Coll Med, Cardiovasc Ctr, Dept Cardiol,Anam Hosp, Seoul, South Korea

[6] Catholic Univ Korea, Coll Med, Dept Internal Med, Div Cardiol, Seoul, South Korea

[7] Gyeongsang Natl Univ, Dept Internal Med, Sch Med, Jinju, South Korea

[8] Gyeongsang Natl Univ, Cardiovasc Ctr, Changwon Hosp, Chang Won, South Korea

[9] Yonsei Univ, Dept Cardiol, Wonju Severance Christian Hosp, Wonju, South Korea

[10] Seoul Natl Univ, Dept Internal Med, Coll Med, Seoul, South Korea

[11] Seoul Natl Univ, Dept Cardiol, Bundang Hosp, Seongnam, South Korea

[12] Hallym Univ, Kangnam Sacred Heart Hosp, Dept Internal Med, Cardiol Div,Coll Med, Seoul, South Korea

[13] Kangwon Natl Univ, Dept Internal Med, Div Cardiol, Sch Med, Chunchon, South Korea

[14] Seoul Natl Univ Hosp, Cardiovasc Ctr, Dept Internal Med, Seoul, South Korea

[15] Dong A Univ Hosp, Dept Cardiol, Busan, South Korea

[16] Univ Ulsan, Ulsan Univ Hosp, Div Cardiol, Coll Med, Ulsan, South Korea

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2023年 / 16卷 / 07期

关键词：

  clopidogrel; drug-eluting stent(s); percutaneous coronary intervention; prognosis; PLATELET REACTIVITY; MYOCARDIAL-INFARCTION; BARE-METAL; OUTCOMES; DEFINITIONS; EVENTS; TRIALS; ASSAY; RISK;

D O I：

10.1016/j.jcin.2023.01.363

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Although there is a growing body of evidence that CYP2C19 genotyping can be beneficial when considering treatment with clopidogrel after percutaneous coronary intervention (PCI), whether a genotype-guided strategy can be generally adopted in routine practice remains unclear among East Asians.OBJECTIVES This study sought to investigate long-term outcomes of patients undergoing clopidogrel-based anti -platelet therapy after drug-eluting stent (DES) implantation according to CYP2C19 genotypes.METHODS From the nationwide multicenter PTRG-DES (Platelet function and genoType-Related long-term proGnosis in DES-treated patients) consortium, patients who underwent CYP2C19 genotyping were selected and classified ac-cording to CYP2C19 loss-of-function allele: rapid metabolizers (RMs) or normal metabolizers (NMs) vs intermediate metabolizers (IMs) or poor metabolizers (PMs). The primary outcome was a composite of cardiac death, myocardial infarction, and stent thrombosis at 5 years after the index procedure. RESULTS Of 8,163 patients with CYP2C19 genotyping, 56.7% presented with acute coronary syndrome. There were 3,098 (37.9%) in the RM or NM group, 3,906 (47.9%) in the IM group, and 1,159 (14.2%) in the PM group. IMs or PMs were associated with an increased risk of 5-year primary outcome compared with RMs or NMs (HRadj: 1.42; 95% CI: 1.01-1.98; P = 0.041), and the effect was more pronounced in the first year (HRadj: 1.67; 95% CI: 1.10-2.55; P = 0.016). The prognostic implication of being an IM and PM was significant in acute coronary syndrome patients (HRadj: 1.88; 95% CI: 1.20-2.93; P = 0.005) but not in those with stable angina (HRadj: 0.92; 95% CI: 0.54-1.55; P = 0.751) (interaction P = 0.028). CONCLUSIONS Among East Asians with clopidogrel-based antiplatelet therapy after DES implantation, CYP2C19 genotyping could stratify patients who were likely to have an increased risk of atherothrombotic events. (Platelet Function and genoType-Related Long-term progGosis in DES-treated Patients: A Consortium From Multi-centered Registries [PTRG-DES]; NCT04734028) (J Am Coll Cardiol Intv 2023;16:829-843) (c) 2023 by the American College of Cardiology Foundation.

引用

页码：829 / 843

页数：15