Orlando，FL---ACC58届年会i2峰会报道，CYP2C19*2 基因型的携带者在PCI术后1年的随访过程中更易发生缺血事件。
由于存在对氯吡格雷无反应的患者（氯吡格雷抵抗），研究者进行了一项实验，试图探讨氯吡格雷抵抗同细胞色素酶P450基因（或者称为CYP2C19）多样性的关系。使用ADP诱导的血小板聚集率以及对接受传统PCI治疗冠心病并且正在服用氯吡格雷的227名患者的1年随访结果来测定CYP2C19*2表型同血小板功能之间的关系。研究发现，CYP2C19*2表型的患者在PCI术后1年的随访过程中有更多的缺血事件发生。

    CYP2C19*2表型在美国人群中约占30%。来自马里兰大学的Paul教授评价：“这项结果首次可以使医生们通过利用检测血小板功能和基因测定的诊断性的方法来改善患者的抗血小板治疗。”具有高血小板活性的患者可能需要其他的P2Y12抑制剂，要么是非前体药物，要么是不高度依赖于CYP2C19而产生活性代谢物的噻吩吡啶类药物。另外，在开始氯吡格雷治疗前，基因测定也可能为这些替代药物的应用提供更好的选择性。

（谭凯 吕树铮  首都医科大学附属北京安贞医院）

GENE VARIANT ASSOCIATED WITH DIMINISHED ANITIPLATELET EFFECT OF CLOPIDOGREL
Orlando， FL – Patients with the CYP2C19*2 genotype had more ischemic events in the one year following percutaneous coronary intervention (PCI) (than whom? AF)， according to research presented during the i2 Summit at the American College of Cardiology’s 58th annual scientific session.

As a result of some patients’ non-responsiveness to clopidogrel， a study was undertaken to link that non-responsiveness to the genetic variability of the Cytochrome P450 gene， or CYP2C19. The relation of the CYP2C19*2 variant to platelet function was measured through ADP-induced platelet aggregation and one-year cardiovascular outcomes in 227 patients using clopidogrel following traditional post-PCI procedures used to treat coronary heart disease. It was determined that those patients with the CYP2C19*2 genotype did in fact have more ischemic events in the one year following PCI.

 The CYP2C19*2 variant is present in about 30 percent of the general United States population.

“This knowledge may enable physicians for the first time to improve individual antiplatelet management by a diagnostic approach utilizing platelet function or genetic testing，” said Paul A. Gurbel， M.D.， lead author from the University of Maryland School of Medicine in Baltimore， Maryland. Patients with high platelet reactivity already on clopidogrel therapy may be offered alternative P2Y12 inhibitors that are either not prodrugs or a thienopyridine not highly dependent on CYP2C19 for metabolic activation. Alternatively， prior to institution of clopidogrel therapy， genetic testing may also lead to more selective use of these alternative agents.”