CYP2C19 genotype-directed P2Y12 inhibitor antiplatelet therapy normalizes risk for major adverse cardiovascular events after percutaneous coronary intervention
| Autor: | Eric A Larson, Lauren Fanta, Catherine Hajek, Marian Petrasko, Valerie Bares, Maheedhar Gedela, Tomasz Stys, Smitha Narayana Gowda, Adam Stys |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Prasugrel RD1-811 Genotype medicine.medical_treatment CYP2C19 030204 cardiovascular system & hematology Coronary artery disease Percutaneous coronary intervention 03 medical and health sciences 0302 clinical medicine P2Y12 Internal medicine medicine Diseases of the circulatory (Cardiovascular) system Humans 030212 general & internal medicine cardiovascular diseases CYP2C19 genotype Acute Coronary Syndrome P2Y12 inhibitors Retrospective Studies business.industry Clopidogrel Cytochrome P-450 CYP2C19 RC666-701 Conventional PCI Cardiology Purinergic P2Y Receptor Antagonists Surgery Original Article Cardiology and Cardiovascular Medicine business Ticagrelor Prasugrel Hydrochloride Mace Platelet Aggregation Inhibitors medicine.drug |
| Zdroj: | Indian Heart Journal Indian Heart Journal, Vol 73, Iss 3, Pp 281-288 (2021) |
| ISSN: | 2213-3763 0019-4832 |
| Popis: | Objective To study the use of CYP2C19 genotyping to guide P2Y12 inhibitor selection to maximize efficacy, and attenuate risk in appropriate patients who underwent PCI for CAD. Methods We performed a retrospective analysis of 868 patients with CAD who received CYP2C19 genotyping after PCI and changed P2Y12 inhibitor based on the results. Patients were divided into two groups based on clopidogrel metabolizer status. Group I: Intermediate (IM) and poor metabolizers (PM). Group II: Ultra-rapid (UM), rapid (RM) and normal metabolizers (NM). Each group was then categorized to one of two treatment arms guided by CYP2C19 genotype. Category 1: IM/PM started on clopidogrel, switched to ticagrelor or prasugrel; 2:IM/PM started on ticagrelor/prasugrel, continued these medications; 3: UM/RM/NM started on ticagrelor/prasugrel, switched to clopidogrel; 4: UM/RM/NM started on clopidogrel, continued clopidogrel. Death due to cardiac causes, bleeding events, non-fatal MI, target vessel revascularization (TVR), and MACE in all four categories were considered at 1, 6 and 12 months. Results We did not observe significant difference between phenotypes for MACE at 1 (p = 0.274), 6 (p = 0.387), and 12 months (p = 0.083). Death due to cardiac causes, MI, and bleeding events were not significant at 1, 6, and 12 months. There was no significant difference in TVR at 6 (p = 0.491), and 12 months (p = 0.423) except at 1 month (p = 0.012). Conclusion CYP2C19 genotype-based intervention can be implemented effectively and reliably to guide selection of P2Y12 inhibitor to optimize patient quality and safety when appropriate in post PCI patients. |
| Databáze: | OpenAIRE |
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