Comparison of the Efficacy and Safety of Cyp2c19 Gene-guided Oral Administration of Different P2Y12 Inhibitors in Elderly Patients with Acute Coronary Syndrome

Abstract

Objective To explore the survival prognosis and safety analysis of the cyp2c19 gene-guided ACS elderly patient group using Tegretol and Clopidogrel. Methods Three hundred and eighty-five ACS patients aged ≥65 years were selected, tested for polymorphisms in the cyp2c19 gene, and divided into two groups according to the oral P2Y12 receptor inhibitor: 320 patients in the clopidogrel group and 165 patients in the tegretol group. Patients were followed up for 1 year after discharge from the hospital, with the primary end point being a composite end point of adverse cardiovascular events including cardiac death, nonfatal infarction, or absence of stroke, and the secondary end point including unstable angina, in-stent stenosis, target vessel revascularization, and all-cause mortality, as well as bleeding events. Results The 1-year rate of ischemic events was lower in patients treated with tegretol compared with the clopidogrel group [28.5% (47/165) versus 26.3% (84/320), P = 0.599], and the difference in the 1-year rate of BARC 2, 3, and 5 events between the two groups was not statistically significant [6.0% (10/165) versus 3.4% (11/320), P = 0.179]. P = 0.179]. Conclusion In elderly patients with cyp2c19-directed ACS, there was no significant difference in survival prognosis, ischemic events, or bleeding risk between tegretol and clopidogrel at 1 year.