支架置入冠状动脉分叉病变后的生物相容性

Biocompatibility of the stent implantation for coronary bifurcation lesions

背景:通过检测CYP2C19基因分型可评估冠状动脉内支架置入患者对氯吡格雷反应性的高低,但目前国内尚缺乏通过检测CYP2C19基因分型指导分叉病变部位支架置入后抗血小板治疗的临床应用。目的:根据CYP2C19基因分型结果,优化冠状动脉分叉病变支架置入后抗血小板治疗方案的效果。方法:纳入136例冠状动脉分叉病变支架置入患者,于支架置入前进行阿司匹林联合氯吡格雷抗血小板治疗,7 d后检测CYP2C19基因分型。若CYP2C19基因分型为*1/*1的作为合格组,支架置入后服用氯吡格雷75 mg/d;若CYP2C19基因分型为*2/*2、*2/*3、*3/*3的作为不合格组,再随机分为2组,一组为常规剂量组,支架置入后即保持氯吡格雷75 mg/d治疗不变,另一组为大剂量组,即增加氯吡格雷剂量为150 mg/d长期服用。随访9个月记录主要心脏不良事件和出血事件发生情况。结果与结论:发生主要心脏不良事件14例中,合格组6例(7.9%)、常规剂量组6例(17.7%)、大剂量组2例(7.7%),合格组发生率明显低于常规剂量组(P<0.05),提示CYP2C19基因分型有较好预测主要心脏不良事件的价值;大剂量组发生率明显小于常规剂量组(P<0.05),说明在CYP2C19基因分型监测下增加抗血小板药物剂量,能明显降低主要心脏不良事件的发生率;大剂量组发生率与合格组比较差异无显著性意义(P>0.05),提示通过检测CYP2C19基因分型,优化氯吡格雷剂量可达到与合格组相同的临床效果。3组出血事件发生率比较差异无显著性意义(P>0.05),提示通过检测CYP2C19基因分型抗血小板治疗不会增加出血风险。

BACKGROUND：To detect CYP2C19 genotype can evaluate sensitivity of patients with coronary artery stent implantation in response to clopidogrel, but there is no clinical use of detecting CYP2C19 genotype to guide antiplatelet therapy after stent implantation for bifurcation lesion of coronary artery in China. OBJECTIVE：To optimize the effect of antiplatelet therapy after stent implantation for coronary bifurcation lesions according to the result of CYP2C19 genotype. METHODS：136 patients with coronary bifurcation lesions undergoing stent implantation were randomly divided into three groups. Patients were given antiplatelet therapy containing clopidogrel and aspirin before stenting and CYP2C19 geneotype was detected after 7 days of stent implantation. ＊1/＊1 of CYP2C19 genotype was defined as qualified group, treated with clopidogrel 75 mg per day after stent implantation. ＊2/＊2,＊2/＊3,＊3/＊3 of CYP2C19 genotypes were defined as unqualified group, and then were randomly further divided into two groups： a routine＆amp;nbsp;dose group treated with clopidogrel 75 mg per day after stent implantation and a high-dose group, treated with clopidogrel 150 mg per day. A 9-month folow-up was performed for recording major adverse cardiac events and bleeding events. RESULTS AND CONCLUSION：There were totaly 14 cases of major adverse cardiac events, 6 （7.9%） in the qualified group, 6 （17.7%） in the routine dose group, and 2 （7.7%） in the high-dose group. The incidence of major adverse cardiac events in the qualified group was obviously lower than that of the routine dose group （P 〈 0.05）, suggesting CYP2C19 genotypes are better to predict major adverse cardiac events. The incidence of major adverse cardiac events in the high-dose group was significantly lower than that of the routine dose group （P 〈 0.05）, indicating increased antiplatelet drug dosage under CYP2C19 genotype monitoring can significantly reduced the incidence of major adverse cardiac events. There was no significant difference between the high-dose group and qualified group （P 〉 0.05）, suggesting optimized clopidogrel doses can achieve the same outcomes as that of the qualified group by detecting CYP2C19 genotype. There was no significant difference in bleeding events among three groups （P 〉 0.05）. The study indicates that the incidence of major adverse cardiac events after coronary bifurcation lesions can be reduced by detecting CYP2C19 genotype that cannot increase the risk of bleeding events.