The Guiding Role Of PEAR1 Gene Detection In Double Antiplatelet Therapy

Objective:To explore the guiding role of PEAR1rs12041331(G > A)genotype test results in antiplatelet therapy for patients with mutant homozygous type(AA)and acute coronary syndrome undergoing elective PCI.Methods:There were 414 patients diagnosed with acute coronary syndrome who were hospitalized in cardiovascular department of the Sanming First Hospital of affiliated to Fujian Medical University between June 2017 and February 2018.All of them were given preoperative loading dose of aspirin 300 mg plus clopidogrel 300 mg.They received percutaneous conronary intervention and their genotypes of PEAR1rs12041331(G>A)were tested.Three groups were divided according to PEAR1rs12041331 genotype(wild homozygous,mutation heterozygous,mutation homozygous)after PCI.Homozygous mutation cases were included in this study,then were randomly divided into aspirin added amount group and cilostazol group.The clinical baseline data of the two groups were compared.They were tested platelet aggregation rate at 24 hours before PCI and 1 month、6 month after PCI.The major adverse cardiac events and bleeding events were followed up at 6 months and 9 months after PCI.By using the SPSS 22.0 statistical software version,measurement data were showed by using mean±standard deviation and compared with the paired t test,while count data were showed by using rate or percentage and compared with chi-square test.It is statistcally significant if the P value is less than 0.05.Results: 1、According to the results of PEAR1rs12041331(G > A)gene testing,414 cases with ACS undegoing elective PCI were divided into three types,which are 106 cases of wild homozygous(GG),120 cases of heterozygous mutation(AG)and 188 cases of homozygous mutation(AA).2、At 6 months after PCI: The major adverse cardiac events had no significantstatistical differences between the two group(P=0.148)and bleeding events had significant statistical differences between the two group(P=0.002).9 months’ results are similar to the above.3、The changes of platelet aggregation rate are below:(1)24 hours after loading dose of aspirin(300 mg)and clopidogrel(300mg)before PCI,platelet aggregation rate(PAR)in both groups had no significant difference(P=0.071).;(2)PAR in cilostazol group was lower than that in aspirin added amount group(p< 0.001)after 1 months of treatment;(3)after 6 months of treatment:PAR in cilostazol group was significantly lower than that in aspirin added amount group(p < 0.001).Conclusions: for patients with mutant homozygous type(AA)and acute coronary syndrome undergoing elective PCI,cilostazol had stronger anti-platelet aggregation function and lower incidence of hemorrhagic events than high-dose aspirin.But there was no significant difference in the incidence of major adverse cardiac events between the two groups.