Effects Of Different Doses Of Naoxintong Capsule Combined With Dual Antiplatelet Therapy In Patients With Cytochrome P4502C19*2Gene Mutation After Percutaneous Coronary Intervention

Objective: To evaluate the effect of the different doses of NXT combined withdual antiplatelet (DA) therapy on platelet function and clinical outcomes inpatients with CYP2C19*2gene mutation after PCI.Methods: All patients received elective PCI and DA therapy in the Department ofCardiovascular Diseases of Fujian Provincial Hospital. Patients with CYP2C19*2gene mutation was detected by PCR-RFLP method. A total of240eligible patientswere enrolled and randomly divided into three groups with each consisting of80patients: DA group, the adjunctive small-dose NXT (SNDA) group (0.8g, thriceper day) and adjunctive large-dose NXT (LNDA) group (1.6g, thrice per day). Allgroups received DA therapy for at least1year while SNDA and LNDA groupsreceived NXT after PCI for3months. Platelet function was assessed at baselineand7d after treatment with conventional aggregometry. The primary endpointswere adverse cardiovascular events (readmission because of unstable angina orprogressive angina, acute myocardial infarction, cardiovascular death) andbleeding events that were recorded during a follow-up of1year.Results:1. The frequency of different genotypes of CYP2C19G681A was in agreementwith Hardy-Weinberg equilibrium in our study(P>0.05),CYP2C19*2GA carriers214（41.54%）and AAcarriers32（6.16%）.2. Baseline platelet function measurements were similar among the three groups.Compared with DA group, percent inhibitions of maximum platelet aggregation(IPAmax)7d after treatment were significantly greater in the SNDA and LNDAgroups（31.22±15.20%，39.91±13.45%vs22.26±15.51%，P<0.01）, IPAmaxin theRNDA group were higher than those in the SNDA group （39.91±13.45%vs31.22±15.20%，P<0.01）. Incidence of adverse cardiovascular events in the SNDA and LNDA groups was lower than those in DA group（13.8%,10.0%vs31.2%，P<0.01）,incidence of adverse cardiovascular events did not significant difference between theSNDA and LNDA groups（13.8%vs10.0%，P>0.05）.The rate of bleeding events didnot differ among the three groups (P>0.05).Conclusion: Adding NXT to DA therapy could strengthen inhibition ofADP-mediated platelet aggregation in a dose-dependent manner compared withDA therapy used alone.Adding NXT to DA therapy could lower the rate of adversecardiovascular events in patients who carried CYP2C19*2undergoing PCI withoutincreasing the risk of bleeding..