Effect of antiplatelet strategy on prognosis of in patients with diabetes mellitus and acute coronary syndrome with different CYP2C19 genotype
10.3760/cma.j.cn121382-20211102-00205
- VernacularTitle:不同 CYP2C19基因型糖尿病合并急性冠脉综合征患者抗血小板策略及对预后的影响
- Author:
Yunyun WANG
1
;
Yingwu LIU
;
Bojiang LIU
;
Bin SU
;
Chaohui LAI
;
Jianlong WANG
Author Information
1. 天津市第三中心医院心脏中心，天津市重症疾病体外生命支持重点实验室，天津市人工细胞工程技术研究中心，天津 300170
- Keywords:
Diabetes;
Acute coronary syndrome;
CYP2C19 gene polymorphism;
Antiplatelet strategy;
Major adverse cardiovascular events
- From:
International Journal of Biomedical Engineering
2022;45(2):118-124
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the effect of different P2Y12 inhibitors on the long-term prognosis of patients with diabetes mellitus (DM) and acute coronary syndrome (ACS), with or without the CYP2C19 loss-of-function (LOF) gene. Method:266 consecutive ACS patients undergoing percutaneous coronary intervention (PCI) were enrolled. According to the CYP2C19 LOF genotype, the patients were divided into rapid metabolizing-type (without the CYP2C19 LOF gene) and moderate-slow metabolizing type (with the CYP2C19 LOF gene). Each type was divided into the A group (with diabetes) and the B group (without diabetes). Each group was divided into the ticagrelor subgroup and the clopidogrel subgroup according to the type of P2Y12 platelet inhibitor. The MACE events were recorded for each subgroup over 3 years, and the prognostic impact of the CYP2C19 LOF genotype and the type of P2Y12 used were analyzed. Results:There were no significant differences in MACE, revascularization, stroke, heart failure rehospitalization, major bleeding, or all-cause mortality among subgroups of patients with rapid metabolizing type at 3 years after PCI (all P>0.05). In patients with moderate-slow metabolizing-type, the use of tegretol significantly reduced the probability of MACE events and cardiac revascularization (all P<0.01) and significantly reduced the reoccurrence of heart attack in patients with DM. Conclusions:In DM combined with ACS patients with rapid metabolizing type, the choice of different P2Y12 inhibitors after PCI had no significant effect on their prognosis. In DM combined with ACS patients with moderate-slow metabolizing type, tegretol not only significantly reduced the incidence of MACE, revascularization, and reinfarction, but also did not increase the risk of major bleeding. In terms of reducing the reoccurrence of heart attack, the benefit of using tegretol in the DM patients was greater than in the non-DM patients.
