基因型导向口服P2Y12抑制剂选择与常规皮格瑞尔治疗对皮肤冠状动脉干预后缺血结果的影响:TAILOR- PCI随机临床试验
Naveen L Pereira1, Michael E Farkouh2, Derek So3
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
JAMA
|August 26, 2020
概括
通过皮肤冠状动脉干预 (PCI) 治疗CYP2C19功能丧失 (LOF) 携带者的基因型导向P2Y12抑制剂治疗没有显著减少缺血事件与传统的克洛皮多格林治疗相比. 这项研究没有发现基因型导向治疗在减少主要心血管不良事件方面具有统计学意义的益处.
科学领域:
- 心血管医学
- 药物基因组学
- 干预心脏病学
背景情况:
- 通过皮肤冠状动脉干预 (PCI) 治疗的CYP2C19功能丧失 (LOF) 变体患者面临缺血事件的风险增加.
- 在这些患者中根据CYP2C19基因型量身定制P2Y12抑制剂的临床益处尚不清楚.
研究的目的:
- 评估基因型导向的口服P2Y12抑制剂策略对PCI后患有CYP2C19 LOF变异的个体的缺血结局的影响.
主要方法:
- 这是一项开放的随机临床试验,涉及5302名因急性冠状动脉综合征 (ACS) 或稳定性冠状动脉疾病 (CAD) 接受PCI的患者.
- 患者被分配到基因型导向组 (LOF载体的蒂卡格勒,非载体的克洛皮多格勒) 或常规组 (克洛皮多格勒).
- 主要终点是12个月内心血管死亡,心肌梗塞,中风,支架血栓和重复性缺血的综合结果.
主要成果:
- 在1849名患有CYP2C19LOF变异的患者中,基因型导向组的4. 0%发生了主要终点,而常规组的5. 9% (HR,0. 66;P=. 06).
- 在所有随机选择的患者中没有统计学上显著的差异 (4. 4% vs 5. 3%; HR, 0. 84; P=. 16).
- 在LOF携带者群体中,重大或轻微出血率没有显著差异 (1.9%对1.6%;HR,1.22;P=.58).
结论:
- 基因型导向的P2Y12抑制剂选择与传统皮多格勒治疗相比,对接受PCI的CYP2C19 LOF载体的缺血事件没有显著的减少.
- 该研究没有达到预先规定的能力,以检测LOF载体中主要终点的向治疗效果.
- 可能需要进一步的研究来澄清药物基因组测试在PCI后抗血小板治疗的指导作用.
相关概念视频
Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
917
Antiplatelet drugs emerge as frontline defenders against the insidious threat of thromboembolic diseases, where abnormal clots obstruct vital blood vessels. These drugs stand as bulwarks, inhibiting platelet aggregation and clot formation, thereby mitigating the risk of life-threatening conditions like myocardial infarction, coronary artery disease, and thrombotic strokes.
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
917
Peripheral Artery Disease III: Interprofessional Care
157
Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
157
Treatment for Pulmonary Arterial Hypertension: Prostacyclin Receptor Agonists
343
Prostacyclin receptor agonists are a class of therapeutic agents integral to managing pulmonary arterial hypertension (PAH). These drugs operate by mimicking the action of prostaglandin I2, or PGI2, a naturally occurring compound in the body.
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...
343
Coronary Artery Disease V: Interprofessional Care
155
Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
155
Treatment for Pulmonary Arterial Hypertension: Receptor Tyrosine Kinase Inhibitors and Calcium Channel Blockers
352
Receptor tyrosine kinase inhibitors (TKIs) and calcium channel blockers (CCBs) are two critical categories of drugs employed in the treatment of pulmonary artery hypertension (PAH). PAH is a disease that causes high blood pressure in the pulmonary arteries, resulting in chest pain, fatigue, and shortness of breath.
TKIs, such as imatinib (Gleevec), are particularly effective in tackling the growth and mitogenic factors that become upregulated in PAH patients. These factors contribute to the...
TKIs, such as imatinib (Gleevec), are particularly effective in tackling the growth and mitogenic factors that become upregulated in PAH patients. These factors contribute to the...
352
Acute Coronary Syndrome III: Diagnostic Studies
120
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
120


