Influence Of CYP2C19Polymorphism On Clopidogrel Resistant Patient

Background: Whether coronary atherosclerotic heart disease patientcould be benefited from clopidogrel lies in CYP2C19polymorphism, thewild genotype people can metabolize clopidogrel normally, reduced theodds of major adverse cardiac events (MACE), such as myocardialinfarction and cardiac death, while the carriers of loss-of-function allelewere affected by clopidogrel resistance, the latter ones could not fulfill thebenefits from clopidogrel.Objective: Observe and analysis how does CYP2C19polymorphisminfluence the odds of major cardiac events and stent thrombosis happenedamong coronary disease patients; analysis the differences of acute coronarysyndrome among different genotype patients.Methods: Enroll61ACS patients from May2012to March2013, they allaccepted percutaneous coronary intervention (PCI) treatment, all taking75milligram clopidogrel orally in the maintenance treatment; Detect the alleleof CYP2C19*1,*2,*3, follow-up the patients through phone call or in theout-patient department, record patients’ details of ACS syndrome,myocardial infarction, cardiac death and stent thrombosis, analysis the relationship between CYP2C19polymorphism and major cardiac events,ACS.Result:61patients were enrolled, among them,25patients are extensivemetabolizers (EM), account for41.0%,29patients are intermediatemetabolizers (IM), account for47.5%,6patients are poor metabolizers,account for11.5%, one person’s genotype and metabolic type can not becategorized. The frequency of CYP2C19*1is64.8%, CYP2C19*2is27.0%, CYP2C19*3is6.6%. Result of clinical follow-up:7people caughtby another myocardial infarction (1in EM group,4in IM group,2in PMgroup),1patient died (IM group),2patients encountered intra-stentthrombosis (IM group);30patients suffered from ACS symptoms (8in EMgroup,17in IM group,5in PM goup). Analysis the factors contributed tomajor adverse cardiac events, found that loss-of-function carriers (IM andPM group) have a higher possibility compared with the wild genotypepatients (EM group), statistically significant (P=0.03), at the same time,there’s significantly higher incidence of ACS symptom in IM and PMgroup (P=0.03). Logistic aggression analysis of major adverse cardiacevents related factors, found Diabetes Mellitus （P=0.049；95%CI1.01-207.13，OR=14.45）and CYP2C19polymorphism（P=0.03；95%CI1.31-463.40， OR=24.66）are both significant factors; Consistently, bylogistic aggression analysis, found the ACS related factors are CCB(P=0.04；95%CI1.11-39.46， OR=6.61) and CYP2C19polymorphism (P=0.04；95%CI1.08-9.37， OR=3.18), statistically significant.Conclusion: CYP2C19polymorphism is a predictor of coronary diseasepatients’ outcome, it happened more on loss-of-function carriers ofmyocardial infarction, cardiac death and stent thrombosis compared to wildtype patients; the loss-of-function carriers have a higher incidence of ACSsyndrome compared with non-carriers.