Correlation Between Clopidogrel Resistance And CYP2C19 Gene Polymorphism In Patients After Emergency PCI

Objectives:To explore the correlation between the antiplatelet efficacy of clopidogrel and CYP2C19 gene polymorphism in patients with ACS after emergency PCIMethods:We collected patients with acute myocardial infarction and emergency PCI who were hospitalized in the Department of Cardiology,Affiliated Hospital of Chengde Medical College from November 2018 to January 2020.The light transmittance aggregometry(LTA)method was used to detect whether the adenosine diphosphate(ADP)-induced platelet aggregation rate was ≥ 50%.The platelet aggregation was divided into the clopidogrel resistance group(CR)and the non clopidogrel response group(NCR),and the CYP2C19 genotypes was detected.According to CYP2C19 genotypes,it is divided into extensive metabolome group(EM:CYP2C19*1/*1),medium metabolome group(MM : CYP2C19*1/*2,CYP2C19*1/*3),and poor metabolome group(PM:CYP2C19*2/*2,CYP2C19*2/*3,CYP2C19*3/*3).The relationship between clopidogrel resistance and CYP2C19 genotypes was analyzed.Results:1 Of the 126 patients,54 were in the CR group and 72 were in the NCR group.Baseline characteristics such as age,gender,hypertension,diabetes,previous cardiovascular and cerebrovascular disease history,smoking history,drinking,blood pressure,white blood cells,platelets,total cholesterol,triglycerides,HDL-C,LDL-C,uric acid,and left ventricular ejection fraction,were no significant difference(P> 0.05).2 The difference in CYP2C19 gene polymorphism between the two groups was statistically significant(P <0.05).3 The difference in Clopidogrel resistance between the three types of CYP2C19 genotypes was statistically significant(P <0.05);there was a statistical difference between the EM and the MM,PM groups(P <0.05),while the difference between the MM group and the PM group was no significant difference(P> 0.05).4 Multivariate logistic regression analysis revealed that diastolic blo od pressure,low-density lipoprotein cholesterol(LDL-C),and CYP2C19 gene polymorphisms were correlated with clopidogrel resistance(P <0.05).5 By plotting the ROC curve of CYP2C19 gene polymorphism and clopidogrel resistance,we found that the CYP2C19 genotype has a stro ng predictive value for the drug reactivity of clopidogrel(AUC> 0.5).Conclusions:The clopidogrel resistance induced by clopidogrel after PCI is correlated with CYP2C19 genotype polymorphism.Detection of CYP2C19 genotype is instructive for evaluating the antiplatelet efficacy of clopidogrel and adjusting clinical medication.