The Follow-up Results Of CYP2C19 Gene Polymorphisms Screening Guided Anti-platelet Therapy After PCI On NST-segment Elevation Acute Coronary Syndrome Patients

[Background and Objective] Aspirin and clopidogrel dual antiplatelet therapy can reduce the occurrence of coronary ischemic events in patients with ACS and/or after PCI. However, many patients on the above-mentioned dual therapy still developed thrombolic events after PCI. Clopidogrel, a prodrug, requires P450 enzymes (CYP450s). CYP2C19 polymorphism leads to the differences in functional protein levels, and the concentration of the active metabolite of clopidogrel, resulting in differences in the efficacy of clopidogrel. In carriers of CYP2C19*2/*2,*3/*3,*2/*3 genes, the concentration of active metabolite of clopidogrel is lower with poor efficacy. The FDA advised doctors to adjust medication and treatment strategies for these cases and recommended the pharmacists to detect the gene of CYP2C19 of patients to understand the metabolism profile of clopidogrel.For those patients with clopidogrel resistance, other drugs are optional. Ticagrelor, a promising anti-platelet drug, does not require metabolic activation. It directly acts on the P2Y12 receptor, and exerts a faster and stronger inhibition of platelet aggregation. For patients after PCI, one-year treatment of Ticagrelor significantly can reduce the relative risk of the composite end point of cardiovascular mortality, myocardial infarction and stroke. New perspectives for antithrombotic therapy in 2014 ESC:for patients with STEMI or NSTEMI, IB classes Recommended:180mg of ticagrelor and a maintenance dose of 90mg twice a day; or prasugrel 60mg and a maintenance dose of 10mg once a day; when these two drugs can not be reached, Clopidogrel can be the second choice.This study was designed to evaluate the CYP2C19 gene polymorphisms screening and to guide anti-platelet treatment after PCI for patients with NSTE-ACS.[Methods] From June 2013 to June 2014,437 patients with NSTE-ACS undergoing PCI were enrolled in CYP2C19 gene polymorphisms screening group (n=213,Group A), and without CYP2C19 gene polymorphisms screening group (n=224,Group B). If patients who is with low concentration of active metabolite of clopidogrel, Ticagrelor was given instead. The MACE rates were analyzed at one month and 6 months.[Results] In group A, through CYP2C19 gene polymorphisms screening,there are 39 patients (18.3.%) showed low concentration of active metabolite of clopidogrel, and Ticagrelor was given instead after PCI. After 30 days, acute myocardial infarction and death rate in Group B were higher than Group A (5.8% vs 1.9%, P=0.014). After 6 months, the MACE rate was no significant difference between A and B groups (Group A 4.2% vs Group B 6.7%, P=0.257).[Conclusions] The CYP2C19 gene polymorphisms screening guided anti-platelet treatment is beneficial to those patients with low concentration of active metabolite of clopidogrel after one month in patients with NSTE-ACS.