FANG Zhen-wei, SHI Xiu-jin, ZHAO Zi-nan, DING Zheng, WEI Juan-juan, ZHOU Yang, LIN Bai-di, ZHOU Peng-xiang, LIN Yang
Objective To evaluate the long-term efficacy and safety of personalized treatment of P2Y12 receptor antagonists in patients with acute coronary syndrome （ACS） or percutaneous coronary intervention （PCI） guided by CYP2C19 genotype. Methods Randomized controlled trials （RCT） about CYP2C19 genotype-guided versus conventional treatment in related databases （PubMed， Embase， Cochrane Library， CNKI， Wanfang， and SinoMed） were searched， from inception to October 28， 2020. The outcome indicators included thrombotic and hemorrhagic events， and the follow-up durations were≥12 months. Meta-analysis was performed using RevMan 5.4 software. Results A total of 7 RCTs were included， involving 4884 cases in the CYP2C19 genotype-guided group and 4864 cases in the conventional group. The Meta-analysis showed that the risk of major adverse cardiovascular events （MACE） （5.22% vs. 6.48%， RR = 0.80， 95%CI ：0.68-0.95， P<0.01）， myocardial infarction （1.70% vs. 2.78%， RR=0.61， 95%CI： 0.47-0.80， P<0.01）， and minor bleeding （6.91% vs. 9.53%， RR = 0.72， 95% CI：0.57-0.92， P<0.01） was significantly lower in the CYP2C19 genotype-guided group than that in the conventional group. Subgroup analysis showed that the differences were statistically significant only in ACS patients ［MACE （4.73% vs. 6.25%，RR=0.75，95%CI：0.63-0.90， P<0.01）， myocardial infarction （1.66% vs. 2.78%，RR=0.60， 95%CI： 0.45-0.79，P<0.01）， minor bleeding（7.73% vs. 11.08%， RR = 0.70， 95%CI：0.54-0.89， P<0.01）］.There was no significant difference in other outcome indicators （all-cause death， cardiovascular death， stroke， stent thrombosis， repeat revascularization， and major bleeding） in the complete and subgroup analysis （all P>0.05）. Conclusion Personalized P2Y12 receptor antagonists according to CYP2C19 genotype for patients with ACS or PCI could reduce the incidence of MACE， myocardial infarction， and minor bleeding. The above evidence mainly came from ACS patients. More large-scale RCTs are needed to further verify the efficacy and safety.
