Clinical study of CYP2C19 gene polymorphism combined with thrombelastography in antiplatelet therapy after coronary intervention

doi:10.3969/j.issn.1672-5301.2018.01.009

Abstract：Objective To investigate the effect of antiplatelet therapy under the guidance of CYP2C19 gene polymorphism combined with thrombus elasticity on the clinical prognosis of patients with coronary atherosclerotic heart disease (CHD) after stent implantation.Methods A total of 168 patients with CHD who underwent CHD and completed successful percutaneous coronary intervention(PCI) from June 2015 to April 2016 were included in the final condition.All completed CYP2C19 genotype and thrombelastography(TEG) test.Patients were divided into two groups:normal metabolic type (including normal and super metabolic type) and abnormal metabolic type (including intermediate and slow metabolic type) according to genotype.And the platelet inhibition rate induced by adenosine diphosphate(ADP) was determined by thrombelastography(TEG) method and divided into NCR (platelet inhibition rate ≥30％)and LCR (platelet inhibition rate ＜30％).Combined with genotype and TEG test results,the genotype for the normal metabolic type+TEG results for NCR patients divided into group A;normal metabolic+TEG results for the LCR or abnormal metabolic+TEG results for the NCR group B group;Abnormal metabolic+TEG results for the LCR group for the C group.Group A and Group B were given Aspirin+Clopidogrel antiplatelet and Group C was given Aspirin+Ticagrelor antiplatelet therapy.The incidence of major bleeding events and adverse cardiovascular events was followed during the 9 to 12 months of follow-up.Results Three groups of patients were gender,age,hypertension,diabetes,hyperlipidemia,smoking,multivessel disease,the number of stent implantation,auxiliary examination(total cholesterol,high density lipoprotein cholesterol,low density lipoprotein cholesterol,creatinine,uric acid).No statistical difference (P＞0.05).There were no significant differences in safety endpoints (major bleeding events,both 0) and end points of efficacy (major adverse cardiovascular events,restenosis of target vascular disease,recurrent angina pectoris) in group A and group B(all P＞0.05).Adverse cardiovascular events were lower in group A than in group A(P=0.042).Restenosis in group C was lower than that in group B(P=0.046).Compared with group A and group B,the incidence of recurrent angina in group C did not increase (P=0.247,P=0.647).No dyspnea occurred in groups A and B,two cases of dyspnea in group C (8.1％) and no increase in bleeding risk in group C.Conclusion According to the CYP2C19 genotype combined with TEG to guide antiplatelet therapy after PCI can reduce the incidence of cardiovascular end points,for the Clopidogrel genotype for the intermediate metabolic/slow metabolic type and combined with ADP inhibition rate of ＜30％ of patients should be given Aspirin+Tegrelilide antiplatelet therapy.