AnalysisoftheriskfactorsofclopidogrelresponseinaHanChinesepopulationundergoingpercutaneouscoronaryintervention

摘要： BackgroundClopidogrelisanantiplateletdrug,whichrequirestheeffluxpumpP-glycoprotein(multidrugresistance-1,MDR1)encodedbytheABCB1geneforintestinalabsorption.However,recentstudiesevaluatingtherelationshipbetweenABCB1geneticpolymorphismsandclopidogrelresponsehaveshownconflictingresultsduetobothgeneticandnon-geneticfactors.ThisstudyaimedtoanalyzetheriskfactorsofclopidogrelresponseinaHanChinesepopulationundergoingpercutaneouscoronaryintervention(PCI).MethodsAtotalof520HanChinesepatientswithcoronaryarterydiseaseundergoingplanneddrug-elutingstentplacementandreceivingdual-antiplatelettherapyweresequentiallyrecruitedandfollowedupfor1year.TheeffectsofclinicalriskfactorsandABCB1geneticpolymorphismsonmajoradversecardiovascularevents(MACE)within1yearorbleedingwithin6monthsafterPCIwereassessed.ResultsThepatientswerecomprisedof82%menand40%smokers.Diabetes,hypertensionandlowejectionfractionwereassociatedwithhigherriskofMACEwithin1yearafterPCI.Thehazardratios[HR]and95%confidenceintervals[CI]were3.15[1.46-6.78],2.78[1.51-5.10]and0.98[0.95-1.00],respectively.Diabetesandfemalewerealsosignificantlyassociatedwithbleedingriskwithin6months(oddsratio[OR][95%CI]:1.96[1.11-3.44]and2.20[1.20-4.05].Useofangiotensin-convertingenzymeinhibitors(ACEIs)wasassociatedwithalowriskofbleedingevents(OR[95%CI]:0.53[0.31-0.91]).TherewasnosignificantimpactofABCB1c.1236C>T,ABCB1c.2677G>T/A,orABCB1c.3435C>TontheriskofMACEwithin1yearoroccurrenceofbleedingwithin6monthsafterPCI.ConclusionsTheseresultssuggestalackofassociationbetweenABCB1geneticvariantsandadversecardiovascularoutcomes.However,diabetes,hypertensionandlowejectionfractionarehighriskfactorsofMACE.Inaddition,diabetesandfemaleareahighriskofbleeding,whichcanbereducedbyuseofACEIs. ... （共12頁）