Influence of CYP2C19 polymorphisms in platelet reactivity and prognosis in an unselected population of non ST elevation acute coronary syndrome |
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Authors: | Tello-Montoliu Antonio Jover Eva Marín Francisco Bernal Agustina Lozano María L Sánchez-Vega Beatriz Pastor Francisco J Hurtado José A Valdés Mariano Vicente Vicente Rivera José |
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Institution: | Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain. |
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Abstract: | Introduction and objectivesCYP2C19*2 and CYP2C19*17 alleles appear to contribute to heterogeneous clopidogrel metabolism. The aims of the present study were to assess the phenotype-genotype relationship of CYP2C19*2 and *17 allele carriage and to explore the clinical impact of those polymorphisms at 6-month follow-up of an acute event in an unselected population of non-ST elevation acute coronary syndrome.MethodsRecruitment for the first and second objectives was 40 stable acute coronary syndrome patients under dual antiplatelet therapy at 12 months after coronary stent placement and an unselected population of 493 consecutive patients with non-ST elevation acute coronary syndrome, respectively. Platelet reactivity was assessed by optical aggregometry induced by adenosine diphosphate and thrombin receptor activating peptide, and by vasodilator-stimulated phosphoprotein phosphorylation measurement using flow cytometry. Genotypes were determined with a TaqMan assay.ResultsOnly the vasodilator-stimulated phosphoprotein phosphorylation measurement detected significant differences in on-clopidogrel platelet reactivity between the wild-type subjects and the CYP2C19*2 (P=.020) and *17 allele carriers (P=.048). No significant difference was found between CYP2C19*2 (HR (95%CI): 1 (0.94-1.55)], P=.984) or *17 (HR (95%CI): 0.93 (0.61-1.43)], P=.753) allele carriage and the occurrence of adverse events at 6-month follow-up.ConclusionsEven though CYP2C19 genotype is associated with variable on-clopidogrel platelet reactivity, it has no significant clinical influence. Prognosis of acute coronary syndromes may be influenced by a myriad of variables.Full English text available from:www.revespcardiol.org |
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Keywords: | CYP citocromo P450 ICP intervención coronaria percutánea IFM intensidad de fluorescencia media PRI-VASP índice de reactividad plaquetaria-fosfoproteína estimulada por vasodilatadores SCASEST síndrome coronario agudo sin elevación del segmento ST TRAP péptido activador del receptor de trombina |
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