CBS 2019
CBSMD教育中心
中 文

推荐文献

Abstract

Recommended Article

Percutaneous coronary intervention using a combination of robotics and telecommunications by an operator in a separate physical location from the patient: an early exploration into the feasibility of telestenting (the REMOTE-PCI study) Treatment of higher-risk patients with an indication for revascularization: evolution within the field of contemporary percutaneous coronary intervention Quantitative Assessment of Coronary Microvascular Function: Dynamic Single-Photon Emission Computed Tomography, Positron Emission Tomography, Ultrasound, Computed Tomography, and Magnetic Resonance Imaging A Novel Algorithm for Treating Chronic Total Coronary Artery Occlusion Individualizing Revascularization Strategy for Diabetic Patients With Multivessel Coronary Disease Effects of dapagliflozin on major adverse kidney and cardiovascular events in patients with diabetic and non-diabetic chronic kidney disease: a prespecified analysis from the DAPA-CKD trial Multimodality imaging in cardiology: a statement on behalf of the Task Force on Multimodality Imaging of the European Association of Cardiovascular Imaging Non-cardiac surgery in patients with coronary artery disease: risk evaluation and periprocedural management

Review Article01 February 2021

JOURNAL:Cardiovasc Drugs Ther. Article Link

Association of CYP2C19 Loss-of-Function Alleles with Major Adverse Cardiovascular Events of Clopidogrel in Stable Coronary Artery Disease Patients Undergoing Percutaneous Coronary Intervention: Meta-analysis

M Biswas, SK Kali. Keywords: stable CAD; CYP2C19 lost of function; MACE

ABSTRACT

PURPOSE - It was aimed to determine the aggregated risk of MACE (major adverse cardiovascular events) in stable CAD patients carrying CYP2C19 LoF alleles taking clopidogrel.


METHODS - Literature was searched in different databases for relevant studies. Aggregated risk was estimated using a fixed/random effect model where p-value<0.05 was considered statistically significant.


RESULTS - In total, 21 studies with 16,194 stable CAD patients were assessed. It was found that patients treated with clopidogrel carrying either one or two CYP2C19 LoF alleles who underwent PCI were associated with significantly increased risk of MACE compared to non-carriers (OR: 1.71, 95% CI: 1.511.94, p<0.00001) that was driven from cardiovascular death (OR: 1.43, 95% CI: 1.021.99, p=0.04), myocardial infarction (OR: 1.75, 95% CI: 1.422.16, p<0.00001), stroke (OR: 2.30, 95% CI: 1.523.47, p<0.0001), and stent thrombosis (OR: 4.08, 95% CI: 2.526.61, p<0.00001). It was also found that carriers of two CYP2C19 LoF alleles were associated with a significantly marked risk of MACE than non-carriers (OR: 2.22, 95% CI: 1.603.09, p<0.00001). Furthermore, the increased risk of MACE remained markedly significant in Asian patients (OR: 2.03, 95% CI: 1.722.40, p<0.00001) and was less significant in western patients (OR: 1.35, 95% CI: 1.111.63, p=0.002). Bleeding events were not significantly different in carriers of CYP2C19 LoF alleles compared to non-carriers (OR: 1.11, 95% CI: 0.851.45, p=0.43).


CONCLUSION - Stable CAD patients treated with clopidogrel and carried CYP2C19 LoF alleles undergoing PCI were associated with significantly increased risk of MACE compared to non-carriers, even markedly significant for Asian patients.