CYP2C19 유전자 다형성에 따른 VerifyNow P2Y12 검사와 뇌졸 중 재발 관련성

Abstract

Background and Purpose: To perform a subgroup analysis of MAESTRO study to explore the relationship between VerifyNow P2Y12 assay and stroke recurrence with regard to CYP2C19 polymorphisms. Methods: Patients who underwent clopidogrel treatment and VerifyNow assay in the MAESTRO study were analyzed. For the study, the efficacy and safety of clopidogrel t treatment for the secondary prevention of ischemic stroke and major vascular event were compared based on CYP2C19 polymorphisms and VerifyNow P2Y12 assay. Results:Two hundred fifty-six patients were entered for this subgroup analysis. The median duration of follow-up was 3.0 years. Thirteen (5.1%) patients had a recurrent stroke: 10 (77%) experienced an ischemic stroke and 3 (23%) experienced an intracerebral hemorrhage. In patients with percent inhibition (% INH) ≥40, the risk of recurrent stroke in the good genotype group was 2.0% and was not significantly different from that in the poor genotype group (4.8%) (P=0.536). In patients with % INH <40, there was no reduction in risk for recurrent stroke in the good genotype group (2.2% vs 6.7%, P=0.225). Though there were no significant differences, a trend toward having more number of recurrent ischemic stroke was observed in % INH <40 and poor genotype group. The risk of recurrent ischemic stroke in the % INH ≥40 and good genotype group was 0% and was 6.7% in the % INH <40 and poor genotype group (P=0.06). Conclusions: Ex vivo platelet function test relating to genetic polymorphisms did not predict stroke recurrence during clopidogrel treatment.