预防性药物基因组测试对抗血小板治疗在现实环境中的临床影响
Amanda Massmann1,2, Kurt D Christensen3,4,5, Joel Van Heukelom6,7
1Sanford Imagenetics, Sioux Falls, SD, 57105, USA. Amanda.Massmann@SanfordHealth.org.
European journal of human genetics : EJHG
|February 29, 2024
概括
预防性CYP2C19基因造型显著影响急性冠状动脉综合征 (ACS) 患者的抗血小板选择. 这种主动的方法会影响最初的药物选择,而不会影响重大心血管不良事件 (MACE) 或医疗保健利用率.
科学领域:
- 药物基因组学 药物基因组学
- 心血管医学 心血管医学
- 临床试验设计 临床试验设计
背景情况:
- CYP2C19 基因定型指导急性冠状动脉综合征 (ACS) 或皮肤冠状动脉干预 (PCI) 后的抗血小板治疗,减少主要心血管不良事件 (MACE).
- 关于预防性CYP2C19基因定型的影响的证据有限,在临床需要出现之前进行.
研究的目的:
- 为了比较预防性,早期和晚期CYP2C19基因型定制对抗血小板选择和患者结局的影响.
- 评估基因型定型时间对药物选择,医疗保健利用和一年内的临床事件的影响.
主要方法:
- 对200名接受ACS或PCI抗血小板治疗的患者病历的回顾性分析.
- 三组的比较:预防性基因型鉴定 (>需要前7天),早期基因型鉴定 (7天内需要),晚期基因型鉴定 (>需要后7天).
- 倾向性得分匹配被用来平衡预防性和早期基因型组之间的患者特征.
主要成果:
- 与早期 (66.7%) 或晚期 (73.2%) 基因型定型 (P=.001) 相比,患有CYP2C19功能丧失等位基因的患者在预防性基因型定型 (18.2%) 时接受克洛皮多格勒的可能性较低.
- 在基因型定型时间组 (P>.21) 中,在专科访问,MACE或出血事件中没有发现显著差异.
结论:
- 预防性CYP2C19基因造型对患有ACS或接受PCI的患者的初始抗血小板药物选择有很大影响.
- CYP2C19基因型定型的时间没有影响患者的治疗结果 (MACE,出血) 或在一年内利用医疗保健.
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