Relation between cytochrome P450 2C19 gene polymorphism and high on-treatment platelet reactivity after interventional and antiplatelet therapy in patients with acute coronary syndrome

Zhang Sujuan; Song Yuqing; Wei Ming; Dong Qian; Wu Qiming; Cheng Xiaoyan

doi:10.3760/j.issn.1673-4777.2019.08.002

Abstract：Objective To explore cytochrome P450(CYP)2C19 gene polymorphism in patients with acute coronary syndrome(ACS) and its correlation with high on-treatment platelet reactivity(HTPR) following aspirin plus clopidogrel antiplatelet therapy after percutaneous coronary intervention (PCI).Methods A total of 128 patients diagnosed of ACS who underwent PCI from January to December 2017 in Beijing Ditan Hospital,Capital Medical University were enrolled.Routine antiplatelet therapy with aspirin and clopidogrel was performed after PCI.Polymorphisms of CYP2C19 gene were tested by polymerase chain reaction sequencing assay;patients with rapid and ultra-rapid metabolism of clopidogrel genotypes were included in normal metabolism group,while patients with intermediate and poor metabolism genotypes were abnormal metabolism group.General data,laboratory indicators of coagulation,biochemical test and platelet reactivity were recorded.The relation between CYP2C19 gene polymorphism and platelet reactivity was analyzed.Results Among the 128 patients,55 patients(43.0％) were normal metabolism genotypes including 1 case of ultra-rapid metabolism and 54 cases of rapid metabolism;73 patients(57.0％) were abnormal metabolism genotypes including 66 cases of intermediate metabolism and 7 cases of poor metabolism.Comorbidity rate of type 2 diabetes mellitus in abnormal metabolism group wassignificantly higher than that in normal metabolism group [39.7％ (29/73) vs 21.8％ (12/55)] (P ＜ 0.05).There were no significant differences in gender,age,non-ST segment elevation ACS,hypertension,hyperlipidemia,smoking,old cerebral infarction,biochemical indicators,maximum amplitude of thrombus,adenosine diphosphate (ADP)-induced platelet-fibrin clot strength,ADP inhibition rate and HTPR incidence between normal and abnormal metabolism groups (all P ＞ 0.05).Pearson analysis showed no significant correlation between low on-treatment platelet reactivity and CYP2C19 genotypes (r =-0.017,P =0.852).Conclusions ACS patients with intermediate and poor metabolism genotypes of CYP2C19 have a higher prevalence of type 2 diabetes mellitus.HTPR on clopidogrel after PCI is not associated with CYP2C19 gene polymorphism.