| Objective To evaluate the efficacy and safety of CYP2C19 gene-guided dual antiplatelet therapy in patients with coronary heart disease undergoing coronary artery bypass transplantation.To investigate the effects of CYP2C19 gene polymorphism and thromboplasmogram platelet inhibition rate on the clinical efficacy and prognosis of coronary artery bypass grafting in patients with coronary heart disease.Methods A retrospective analysis was conducted to collect the information of 166 patients with coronary artery disease who underwent coronary artery bypass grafting(CABG)in the Second People’s Hospital of XX City from February 2015 to February 2022.According to the postoperative antiplatelet therapy regimen,the patients were divided into individual treatment group and conventional treatment group.Patients guided by CYP2C19 gene polymorphism were included in the individualized treatment group,and patients receiving dual antiplatelet therapy(DAPT)with aspirin combined with standard dose of clopidogrel were included in the conventional treatment group.The general situation,major adverse cardiovascular events(MACE),the occurrence of bleeding events,and the patency of bridging vessels 12 months after surgery were compared between the two groups.At the same time,the platelet inhibition rate of patients in the individualized treatment group was measured by TEG,and the relationship between the platelet inhibition rate and the clinical prognosis of patients in the individualized treatment group was further analyzed.Results According to CYP2C19 gene testing and individualized medication guidance,of 166 patients,80(48.18%)were included in the individualized treatment group and 86(51.81%)in the conventional treatment group.There were no significant differences in age,height,weight,smoking history and previous disease history between the two groups(P>0.05).MACE events in two groups: 1 case of cardiovascular death,0 cases of myocardial infarction,1 case of stroke in the individualized treatment group;In the conventional treatment group,there were 3 cases of cardiovascular death,2 cases of myocardial infarction and 4 cases of stroke.The difference was statistically significant(P<0.05).Bleeding events in the two groups: 10 cases of minor bleeding(BARC bleeding grade 1-2)and 3 cases of major bleeding(BARC bleeding grade 3)occurred in the individualized treatment group.In the conventional treatment group,there were 3 cases of minor bleeding and 2 cases of major bleeding,the difference was statistically significant(P<0.05).Patency of bridging vessels 12 months after surgery in the two groups: According to the results of coronary artery CTA,75 arterial Bridges and 194 venous Bridges were found in the individualized treatment group,with a patency rate of 93.68%(252/269).There were 79 arterial Bridges and 202 venous Bridges in the conventional treatment group,and the patency rate of bridging vessels was 85.05%(239/281),with significant difference between the two groups(P<0.001).Subgroup analysis was performed for patients in the individualized treatment group,and the patients were grouped according to the results of TEG platelet inhibition rate.There were 7 cases in the substandard group,62 cases in the qualified group,and 21 cases in the exceeded group.There were no significant differences in age,height,weight and previous disease history among the three groups(P>0.05).The platelet inhibition rate was statistically different among the three groups(P<0.05).Bleeding events of patients in the three groups: No bleeding events occurred in the substandard group,1 bleeding event occurred in the qualified group,and 12 bleeding events occurred in the exceeded group,with statistical significance(P<0.05).According to the coronary CTA results 12 months after surgery,the total number of bridging vessels in the TEG substandard group was 24,and the bridging patency rate was 37.5%(9/24).The total number of bridge vessels in TEG standard group was 180,and the patency rate of bridge vessels was 98.89%(178/180).The total number of bridging vessels in the TEG super-standard group was 65,and the vascular patency rate in the TEG standard group was 100%(65/65),with significant difference among the three groups(P<0.001).Conclusion Individualized antiplatelet therapy guided by CYP2C19 gene can reduce the incidence of postoperative MACE events in CABG patients and improve the bridging patency rate one year after surgery,but at the cost of increased bleeding events.Thrombologram is valuable in evaluating the risk of bleeding,thrombosis and long-term patency of bridging vessels after DAPT.CYP2C19 gene detection was used to select postoperative DAPT regimen for CABG in patients with coronary heart disease before treatment,and TEG was used to monitor the anti-platelet effect of drugs after treatment.The precise individualized administration of the two combined detection technologies may help reduce the occurrence of MACE and bleeding events and improve the long-term patency rate of bridging vessels. |
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