CYP2C19Gene Polymorphism And Coronary Artery Stent Implantation Correlation Of In Stent Restenosis

Background and Objective: Coronary in stent restenosis seriously affect thelong-term prognosis of interventional therapy of coronary heart disease, how toprevent and avoid the in stent restenosis is always an important topic in the researchof the Department of cardiology.With the continuous development of medicaltechnology, interventional therapy of coronary heart disease has experienced threeimportant stages, namely, percutaneous transluminal coronary angioplasty, bare metalstent and drug eluting stent implantation, now mainly in the drug eluting stentimplantation in the treatment, drug coating can effectively inhibit vascular endothelialhyperplasia, so as to reduce in stent restenosis.Nevertheless, different degreesoccurred within the stent restenosis and serious acute thrombosis in10%-15%patientsin the stenting is still.Welt et al. Complete describes molecular and cytologicalmechanism of in stent restenosis, which occurs in the inflammatory reaction in stentrestenosis effect more precisely, and the formation of local support micro thrombosiscan cause inflammatory reaction.Therefore,anti platelet aggregation of microthrombosis to prevent, reduce inflammation, and reduce in stent restenosis hasimportant significance. Clopidogrel and aspirin is now the most important antiplateletdrugs, from the chemical structure, and clopidogrel antiplatelet activity is110times ofaspirin, therefore in the clopidogrel and aspirin combined with clopidogrel dualantiplatelet, holds the very great influence.Because clopidogrel need to bemetabolized by P450to exert antiplatelet effect, CYP2C19gene polymorphismaffects seriously the clopidogrel metabolism, so the research on CYP2C19genepolymorphism and coronary artery stenting relevance restenosis after stent for antiplatelet therapy guidance scheme after operation, reduce the incidence of in stentrestenosis rate the important value. Research Methods: The research object from2012September to2014Octoberperiod in China-Japan Union Hospital of Jilin University department of cardiologydepartment of cardiology and complete data for coronary artery stent implantation inpatients (all drug coated stents) were230cases, including163cases of male, female67cases, age45-85years old, average61+12.55years.Records of patients in generalincluding gender, age, body weight, whether the merger history of hypertension ordiabetes, smoking history, MI; and measured and recorded the lesion, stent restenosis,stent length, total number of EF values, troponin, creatinine, contrast agents forvolume, platelet count in patients with drug application, related according to therecord; stenting after half a year to1years back to the hospital again for coronaryangiography, according to the extent of the lesion is divided into the restenosis andnon stenosis group; according to the determination of genotypes in patients dividedinto fast metabolism, metabolism and slow metabolism group; according to whetherthe application of insulin treatment were divided into2groups according to support;diameter is divided into more than3.0mm and <3.0mm group; according to theabnormal blood lipid level and divided into2groups, observation and statisticalanalysis of the project.Measurement data using mean standard deviation (+s) said,count data is expressed as a rate or frequency. Comparison between the two groupdata to t for test; count data comparison between the two groups using2test;correlation analysis using R*C square test list card and Pearson trend test results. Ofthe factors that may affect the results of the two classification by single factorLogistics regression analysis, using P<0.05as the difference had statisticalsignificance.Research Results: To eliminate the effect of abnormal LDL-C or not, fallapplication of insulin or not, the diameter of the stent of the three elements, fastmetabolism and metabolic type OR value from0.203before and0.393changes of0.091and0.257, visible, LDL-C anomaly or not, and whether the application ofinsulin, stent diameter of these three factors exist may have a negative effect may exaggerate the extensive metabolizers and metabolism in the type of stent restenosis,but did not cause the overall conclusion of the change, so we can conclude that,LDL-C is normal or not, and whether the application of insulin, stent diameter ofthese three factors had little effect on the phenotype of in stent restenosis.Conclusions:1. take clopidogrel antiplatelet therapy in patients with different genotypes, theoccurrence of restenosis rate showed a linear relationship, namely fast metabolic type<metabolic type <slow metabolic type.2. LDL-C level of diabetes, insulin application or not and the diameter of thestent size influence restenosis, but the final did not affect the results above.