| ObjectiveTo investigate the distribution of CYP2C19 gene polymorphism in patients with major adverse cardiovascular events(MACE)after coronary artery stenting(PCI)in patients with acute coronary syndrome(ACS).MethodsA total of 600 ACS patients after PCI who were diagnosed in the Department of Cardiology,The Second Affiliated Hospital of Shenyang Medical College from September 2016 to December 2017 were enrolled and followed up.101 patients with major adverse cardiovascular events within one year after the operation were assigned into the observation group(MACE group)while 97 patients of the 499 patients without major adverse cardiovascular events within one year after the operation were randomly assigned into the control group(non-MACE group).The general clinical data,imaging examinations and biochemical indicators of the two groups were compared,and platelet aggregation rate and the CYP2C19 gene polymorphism were detected in the two groupsResults1.Among the enrolled 198 patients,there were 90 patients with unstable angina(45.5%),63 with myocardial infarction with ST-segment-elevation(31.8%),and 45 with myocardial infarction non-ST-segment-elevation(22.7%).The clinical baseline materials of patients from both groups showed no significant differences(P>0.05).2.The ADP receptor-induced platelet aggregation rate in the MACE group and the non-MACE group at one-year follow-up were(32.10±6.36)%and(29.98±5.73)%,indicating that the platelet aggregation rate of MACE group was higher than that of non-MACE group,and the differences showed statistical significance(P<0.05).3.Among the 101 patients in the MACE group,2 patients(2.0%)had non-fatal myocardial infa rction within 12 months after PCI,1 patient(1.0%)had stent thrombosis,21 patients(20.8%)had re-revamination(re-PCI or CABG),and 77 patients(76.2%)had angina attack(GRACE score>140)4.The CYP2C19 allele and gene frequency in this study were consistent with the Hardy-Weinberg equilibrium(P>0.05).Among the 198 patients who met the criteria and underwent genotyping test,the constituent ratio of rapid metabolism,medium metabolism and slow metabolism of clopidogrel of patients enrolled in the study was 35.3%(70/198),47.5%(94/198)and 17.2%(34/198)respectively.The ratio of carrying frequency of*2,*3 and*17 alleles in ACS patients were 36.9%(146/396),4%(16/396)and 0.5%(2/396).101 in MACE group(16.8%),among which,there were 29 rapid metabolism(28.7%),50 medium metabolism(49.5%)and 22 slow metabolism(21.8%)and 97 in non-MACE group(16.2%),among which,there were 41 rapid metabolism(42.3%),44 medium metabolism(45.4%)and 12 slow metabolism(12.4%).The patients with CYP2C19 functional deficiency from MACE group and non-MACE group were respectively 72(71.3%)and 56(57.7%),which showed patients with CYP2C19 functional deficiency in MACE group were more than those in non-MACE group,and the differences presented statistical significance(P<0.05).5.Logistic regression analysis was conducted to analyze the correlation between the clinical factors and some biochemical indicators and MACE occurrence after PCI and the results showed that drinking,platelet aggregation,CYP2C19 functional deficiency alleles and the level of hemoglobin were both associated with adverse cardiovascular events(MACE)(P<0.05),and drinking,platelet aggregation,CYP2C19 functional deficiency alleles were risk factors,while the level of hemoglobin was protective factorsConclusionPatients with acute coronary syndrome(ACS)who have major adverse cardiovascular events(MACE)after percutaneous coronary intervention(PCI)have more CYP2C19*2 and CYP2C19*3 alleles,with the maximum platelet aggregation(MAR)is higher. |
PDF Full Text Request