A meta-analysis of cyp2c19 gene testing on the prognosis of patients aged 60 years and older with acute coronary syndrome
DOI:
https://doi.org/10.54097/ijbls.v2i1.5222Keywords:
Cyp2c19 gene, Genetic testing, Elderly, Tigretol, Clopidogrel, Acute coronary syndrome, Clinical efficacyAbstract
Objective Whether cyp2c19 gene testing is clinically beneficial for patients aged 60 years and older with acute coronary syndrome. Methods A computerized search of WIFANG, CNKI, CBM and Vipul databases was performed to comprehensively collect RCTs on cyp2c19 gene-guided selection of different antiplatelet regimens or placebo or blank control comparisons. Results A total of 8 RCTs were included. cyp2c19 gene-guided prognosis regarding antiplatelet regimens in the elderly was better in the tigretol group than in the clopidogrel group, with statistically significant differences. CONCLUSION: Current evidence suggests that in the context of acute coronary syndromes in patients, with reference to the cyp2c19 gene and age, the overall clinical benefit of tigretol may be much better than clopidogrel, although patients may be at greater risk of bleeding.
Downloads
References
M. Valgimigli, “2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: the Task Force for Dual Antiplatelet Therapy in Coronary Artery Disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS)” in Eur Heart J, 39 (2018), pp. 213-260.
A. Schomig, A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents . N Engl J Med, 334 (1996), pp. 1084-1089.
P.A.Gurbel, Clopidogrel for coronary stenting: response variability, drug resistance, and the effect of pretreatment platelet reactivity. Circulation, 107 (2003), pp. 2908-2913.
J.L. Mega, Reduced-function CYP2C19 genotype and risk of adverse clinical outcomes among patients treated with clopidogrel predominantly for PCI: a meta-analysis. JAMA, 304 (2010), pp. 1821-1830.
A.R. Shuldiner, Association of cytochrome P450 2C19 genotype with the antiplatelet effect and clinical efficacy of clopidogrel therapy. JAMA, 302 (2009), pp. 849-857.
W. Hochholzer, “Impact of cytochrome P450 2C19 loss-of-function polymorphism and of major demographic characteristics on residual platelet function after loading and maintenance treatment with clopidogrel in patients undergoing elective coronary stent placement”. J Am Coll Cardiol, 55 (2010), pp. 2427-2434.
M.J. Price, Influence of genetic polymorphisms on the effect of high- and standard-dose clopidogrel after percutaneous coronary intervention: the GIFT (Genotype Information and Functional Testing) study. J Am Coll Cardiol, 59 (2012), pp. 1928-1937.
E Kelly,Standardizing terms for clinical pharmacogenetic test results: consensus terms from the Clinical Pharmacogenetics Implementation Consortium (CPIC)[J]. Genetics in Medicine: Official journal of the American College of Medical Genetics and Genomics, 2017, 19(Database issue) : 215-223.
NL Pereira, Clopidogrel pharmacogenetics. State-of-the-Art Review and the TAILOR-PCI Study. Circ Cardiovasc Interv. 2019;12:e007811.
ScottSA, Clinical pharmacogenetics implementation consortium guidelines for CYP2C19 genotype and clopidogrel therapy：2013 update[J]．Clin Pharmacol Ther，2013，94(3)：317–323.DOI：10.1038/clpt.2013.105.
B Ibanez, “2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)”. Eur Heart J 2018;39:119-77.
GN Levine, “2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines”. J Am Coll Cardiol 2016;68:1082-115.
L Wallentin, Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2009;361:1045-57.
SD Wiviott, Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2007;357:2001-15.
J.Y. Moon,Evolution of coronary stent technology and implications for duration of dual antiplatelet therapy. Prog Cardiovasc Dis, 60 (2018), pp. 478-490.
L, Wallentin,Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2009;361:1045-57.
SD Wiviott, Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2007;357:2001-15.
L Wallentin, Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med, 361 (2009), pp. 1045-1057.
F Tian, Effect of tegretol and clopidogrel on complications and prognosis after emergency percutaneous coronary intervention in elderly patients with acute ST-segment elevation myocardial infarction[J]. Hebei Medicine,2021,27(02):313-317.
X Ma, Efficacy study of tegretol applied in the real world after direct percutaneous coronary intervention for acute coronary syndrome in the elderly[J]. Journal of Practical Hospital Clinics,2021,18(03):13-16.
Q Chen, The efficacy and safety of clopidogrel and tigretol in elderly patients with acute coronary syndrome[J]. Chinese Journal of Evidence-Based Cardiovascular Medicine,2021,13(03):337-341.
LH Huang, Effect of dual antiplatelet regimen on cardiovascular adverse events after intervention in elderly patients with acute coronary syndrome with type 2 diabetes mellitus[J]. Cardiovascular disease control knowledge,2021,11(05):20-22.
YJ Liang, Effect of different antiplatelet drug regimens on platelet reactivity, MACE and risk of bleeding events in elderly patients with coronary artery disease complicated by type 2 diabetes mellitus treated with PCI[J]. Lingnan Journal of Cardiovascular Diseases,2019,25(01):48-52.
J Qi, Comparative study on the safety and efficacy of clopidogrel and tigretol in elderly non-ST-segment elevation acute coronary syndrome[J]. Chinese Journal of Geriatric Cardiovascular Diseases,2020,22(12):1259-1262.
YY Gao, The efficacy and safety of different P2Y12 receptor antagonists in elderly patients with acute coronary syndrome[J]. Chinese Journal of Geriatric Cardiovascular Diseases,2020,22(03):314-316.
L Cai, Antiplatelet efficacy and safety analysis of tegretol in patients over 75 years old with coronary intervention[J]. Chinese Journal of Geriatric Cardiovascular and Cerebrovascular Diseases,2018,20(03):234-236.
JP Higgins, Cochrane Handbook for Systematic Reviews of Interventions (Version 5.4). Available at: http:/ /www.cochrane handbook.org.
