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Tailored Adjunctive Cilostazol Therapy Based on CYP2C19 Genotyping in Patients With Acute Myocardial Infarction　- The

Koichi Kaikita1, Hiromi Yoshimura2, Masanobu Ishii1

  • 1Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University.

Circulation Journal : Official Journal of the Japanese Circulation Society
|May 11, 2018
PubMed

Insights

Patients with reduced CYP2C19 function undergoing antiplatelet therapy face higher acute myocardial infarction (AMI) risk. Genotype-guided cilostazol therapy effectively reduced platelet reactivity in these patients.

Area of Science:

  • Cardiology
  • Pharmacogenomics
  • Clinical Medicine

Background:

  • Patients with reduced-function CYP2C19 genotypes on dual antiplatelet therapy (DAPT) exhibit increased risk of acute myocardial infarction (AMI).
  • CYP2C19 genotype influences clopidogrel metabolism and efficacy.

Purpose of the Study:

  • To investigate the impact of CYP2C19 genotype-tailored, adjunctive cilostazol therapy on AMI treatment.
  • To assess the efficacy of personalized antiplatelet strategies based on genetic profiles.

Main Methods:

  • 138 patients with suspected AMI were genotyped post-percutaneous coronary intervention (PCI).
  • Patients with reduced-function CYP2C19 alleles were randomized to DAPT or DAPT plus 14-day cilostazol.
  • Platelet reactivity (PRU) and cardiac biomarkers were monitored post-PCI.

Main Results:

  • Adjunctive cilostazol significantly reduced PRU levels in CYP2C19 reduced-function carriers compared to DAPT alone.
  • PRU levels in the cilostazol group returned to baseline levels after drug discontinuation.
  • Lower B-type natriuretic peptide levels were observed in the cilostazol group at 14 days post-PCI.

Conclusions:

  • CYP2C19 genotype-guided adjunctive cilostazol therapy is beneficial for AMI patients with reduced-function alleles.
  • Personalized antiplatelet strategies can optimize treatment outcomes in cardiology.
Abstract

Keywords:
Acute myocardial infarctionAntiplatelet therapyCYP2C19CilostazolPlatelet aggregation

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