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首页> 外文期刊>Platelets >Risk of major adverse cardiovascular events of CYP2C19 loss-of-function genotype guided prasugrel/ticagrelor vs clopidogrel therapy for acute coronary syndrome patients undergoing percutaneous coronary intervention: a meta-analysis
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Risk of major adverse cardiovascular events of CYP2C19 loss-of-function genotype guided prasugrel/ticagrelor vs clopidogrel therapy for acute coronary syndrome patients undergoing percutaneous coronary intervention: a meta-analysis

机译：CYP2C19主要不良心血管事件的风险缺失函数基因型引导普拉苏格雷/ TICAGREROROR对经皮冠状动脉介入的急性冠状动脉综合征患者的氯吡格雷治疗：META分析

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The most effective antiplatelet treatments for acute coronary syndrome (ACS) patients carryingCYP2C19loss-of-function (LoF) alleles undergoing percutaneous coronary intervention (PCI) is still debating and conflicting. It was aimed to compare the efficacy and safety endpoints for these patients treated with alternative P2Y12 receptor blockers (e.g. prasugrel or ticagrelor) against clopidogrel. Literature was searched in PubMed, Cochrane library, Synapse and 1000 Genomes databases following PRISMA guidelines for identifying relevant studies. Aggregated risk was estimated by RevMan software using either fixed/random-effects models wherePvalues<0.05 (two-sided) were considered statistically significant. Nine studies comprising 16,132 ACS patients undergoing PCI were included in this analysis in which 2,746 and 2,640 patients were in theCYP2C19LoF clopidogrel and alternatives treatment group, respectively. It was demonstrated that patients treated with prasugrel or ticagrelor significantly reduced the risk of MACEs (RR 0.58; 95% CI 0.45-0.76;P<0.0001) as compared to patients with clopidogrel where both groups carryingCYP2C19LoF alleles. Subgroup analysis showed that prasugrel or ticagrelor significantly reduced the risk of cardiovascular death (RR 0.44; 95% CI: 0.25-0.74;P=0.002) and MI (RR 0.60; 95% CI: 0.44-0.81;P=0.0008) while other clinical outcomes were not found statistically significant between these two groups; stroke (RR 0.77; 95% CI: 0.43-1.38;P=0.39), stent thrombosis (RR 0.67; 95% CI: 0.38-1.18;P=0.17), unstable angina (RR 0.55; 95% CI: 0.13-2.33;P=0.42), revascularisation (RR 0.79; 95% CI: 0.28-2.24;P=0.66). Bleeding events were not found significantly different between these groups (RR 1.06; 95% CI: 0.88-1.28;P=0.55). Considering efficacy and safety, alternative antiplatelets (e.g. prasugrel or ticagrelor) may be regarded as better treatment option as compared to clopidogrel for ACS patients undergoing PCI.
机译：对于携带CYP2C19功能丧失（LoF）等位基因的急性冠脉综合征（ACS）患者进行经皮冠状动脉介入治疗（PCI）时，最有效的抗血小板治疗方法仍存在争议和冲突。本研究的目的是比较用P2Y12受体阻滞剂（如普拉格雷或替卡格雷）替代氯吡格雷治疗的患者的疗效和安全性终点。文献在PubMed、Cochrane图书馆、Synapse和1000个基因组数据库中搜索，遵循PRISMA的相关研究鉴定指南。RevMan软件使用固定/随机效应模型估计总风险，其中P值<0.05（双侧）被认为具有统计学意义。本分析包括9项研究，包括16132名接受PCI的ACS患者，其中2746名和2640名患者分别属于CYP2C19LOF氯吡格雷和替代治疗组。研究表明，与氯吡格雷组相比，普拉格雷或替卡格雷组患者发生MACE的风险显著降低（RR 0.58；95%可信区间0.45-0.76；P<0.0001），氯吡格雷组和氯吡格雷组均携带CYP2C19LOF等位基因。亚组分析显示，普拉格雷或替卡格雷显著降低心血管死亡风险（RR 0.44；95%可信区间：0.25-0.74；P=0.002）和心肌梗死风险（RR 0.60；95%可信区间：0.44-0.81；P=0.0008），而其他临床结果在这两组之间无统计学意义；卒中（RR 0.77；95%CI:0.43-1.38；P=0.39）、支架血栓形成（RR 0.67；95%CI:0.38-1.18；P=0.17）、不稳定型心绞痛（RR 0.55；95%CI:0.13-2.33；P=0.42）、血运重建（RR 0.79；95%CI:0.28-2.24；P=0.66）。两组之间的出血事件无显著差异（RR 1.06；95%可信区间：0.88-1.28；P=0.55）。考虑到疗效和安全性，对于接受PCI的ACS患者，与氯吡格雷相比，替代抗血小板药物（如普拉格雷或替卡格雷）可能被视为更好的治疗选择。

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