Clopidogrel is the mainstay for antiplatelet treatment after percutaneous coronary intervention (PCI). The relationship of platelet reactivity and genetic polymorphism with clinical outcomes with newer-generation drug-eluting stents is unclear. We analysed 4,587 patients for the most powerful single-nucleotide polymorphisms (CYP2C19, CYP2C9, ABCB1, PON1, and P2Y12) related to on-treatment platelet reactivity (OPR). The optimal cut-off value of high OPR for major adverse thrombotic events was 266. CYP2C19 was significantly associated with high OPR and the number of CYP2C19*R (*2 or *3) alleles was proportional to the increased risk of high OPR. Death, myocardial infarction (MI), stroke, stent thrombosis, and bleeding events were assessed during a 1-year follow-up period. Primary endpoints were death and non-fatal MI. The cumulative 1-year incidence of death and stent thrombosis was significantly higher in patients with CYP2C19*2/*2, CYP2C19*2/*3, and CYP2C19*3/*3 (Group 3) than in patients with CYP2C19*1/*1 (Group 1). Multivariate Cox proportional hazard model showed that cardiac death risk was significantly higher in Group 3 than in Group 1 (hazard ratio 2.69, 95% confidence interval 1.154-6.263, p = 0.022). No association was reported between bleeding and OPR. Thus, CYP2C19 may exert a significant impact on the prognosis of PCI patients even in the era of newer-generation drug-eluting stents.

中文翻译：

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经皮冠状动脉介入治疗后遗传变异对血小板反应性和一年临床结局的影响：一项前瞻性多中心注册表研究。

氯吡格雷是经皮冠状动脉介入治疗（PCI）后抗血小板治疗的主要手段。新一代药物洗脱支架的血小板反应性和遗传多态性与临床结果之间的关系尚不清楚。我们分析了4,587例与治疗中血小板反应性（OPR）相关的最有效的单核苷酸多态性（CYP2C19，CYP2C9，ABCB1，PON1和P2Y12）。对于主要的不良血栓事件，高OPR的最佳临界值为266。CYP2C19与高OPR显着相关，CYP2C19 * R（* 2或* 3）等位基因的数目与高OPR风险增加成正比。在1年的随访期内评估了死亡，心肌梗塞（MI），中风，支架血栓形成和出血事件。主要终点是死亡和非致命性心肌梗死。CYP2C19 * 2 / * 2，CYP2C19 * 2 / * 3和CYP2C19 * 3 / * 3（第3组）患者的1年累积死亡和支架内血栓形成发生率显着高于CYP2C19 * 1 /患者* 1（第1组）。多元Cox比例风险模型显示，第3组的心脏死亡风险显着高于第1组（风险比2.69，95％置信区间1.154-6.263，p = 0.022）。出血与OPR之间无关联的报道。因此，即使在新一代药物洗脱支架时代，CYP2C19也可能对PCI患者的预后产生重大影响。多元Cox比例风险模型显示，第3组的心脏死亡风险显着高于第1组（风险比2.69，95％置信区间1.154-6.263，p = 0.022）。出血与OPR之间无关联的报道。因此，即使在新一代药物洗脱支架时代，CYP2C19也可能对PCI患者的预后产生重大影响。多元Cox比例风险模型显示，第3组的心脏死亡风险显着高于第1组（风险比2.69，95％置信区间1.154-6.263，p = 0.022）。出血与OPR之间无关联的报道。因此，即使在新一代药物洗脱支架时代，CYP2C19也可能对PCI患者的预后产生重大影响。