Biocompatibility of the stent implantation for coronary bifurcation lesions

Chen Xin-jing

doi:10.3969/j.issn.2095-4344

Abstract：BACKGROUND:To detect CYP2C19 genotype can evaluate sensitivity of patients with coronary artery stent implantation in response to clopidogrel, but there is no clinical use of detecting CYP2C19 genotype to guide antiplatelet therapy after stent implantation for bifurcation lesion of coronary artery in China. <br> OBJECTIVE:To optimize the effect of antiplatelet therapy after stent implantation for coronary bifurcation lesions according to the result of CYP2C19 genotype. <br> METHODS:136 patients with coronary bifurcation lesions undergoing stent implantation were randomly divided into three groups. Patients were given antiplatelet therapy containing clopidogrel and aspirin before stenting and CYP2C19 geneotype was detected after 7 days of stent implantation. *1/*1 of CYP2C19 genotype was defined as qualified group, treated with clopidogrel 75 mg per day after stent implantation. *2/*2,*2/*3,*3/*3 of CYP2C19 genotypes were defined as unqualified group, and then were randomly further divided into two groups: a routine dose group treated with clopidogrel 75 mg per day after stent implantation and a high-dose group, treated with clopidogrel 150 mg per day. A 9-month folow-up was performed for recording major adverse cardiac events and bleeding events. <br> RESULTS AND CONCLUSION:There were totaly 14 cases of major adverse cardiac events, 6 (7.9%) in the qualified group, 6 (17.7%) in the routine dose group, and 2 (7.7%) in the high-dose group. The incidence of major adverse cardiac events in the qualified group was obviously lower than that of the routine dose group (P < 0.05), suggesting CYP2C19 genotypes are better to predict major adverse cardiac events. The incidence of major adverse cardiac events in the high-dose group was significantly lower than that of the routine dose group (P < 0.05), indicating increased antiplatelet drug dosage under CYP2C19 genotype monitoring can significantly reduced the incidence of major adverse cardiac events. There was no significant difference between the high-dose group and qualified group (P > 0.05), suggesting optimized clopidogrel doses can achieve the same outcomes as that of the qualified group by detecting CYP2C19 genotype. There was no significant difference in bleeding events among three groups (P > 0.05). The study indicates that the incidence of major adverse cardiac events after coronary bifurcation lesions can be reduced by detecting CYP2C19 genotype that cannot increase the risk of bleeding events.