To Compare The Curative Effect Of High Dose Of Clopidogrel Between Han And Uygur Patients Carrying CYP2C19*2,*3 Non-functional Allele,after Receiving Elective Or Emergency Percutaneous Coronary Stent Implantation

Object:To find out if there is different clinical efficacy of clopidogrel 150mg/day therapy between Han and Uygur patients carrying CYP2C19 *2, *3 non-functional allele,after receiving elective or emergency PCI(percutaneous coronary stent implantation). Methods:In strict accordance with inclusion and exclusion criteria, we prospectively enrolled 400 patients diagnosed with acute coronary syndrome and received PCI from November 2014 to July 2015 at our hospital.According to the result of CYP2C19 genetic testing,we divided all patients into two groups: poor metabolizer group and normal metabolizer group.The patients in the normal metabolizer group are routinely given 75 mg clopidogrel and the patients in the poor metabolizer group are given 150 mg clopidogre,both groups were followed up for 30±3 days after PCI.Follow-up methods include: readmission,out-patient follow-up and telephone follow-up.The primary endpoint events include: repeat acute myocardial infarction,repeat angina,cardiac death,stent thrombosis,nonfatal stroke,fatal and life-threatening bleeding events.Secondary endpoints include: minor bleeding and slight bleeding events.Results:(1)In the poor metabolizer group,the incidence of repeat acute myocardial infarction(1.8%与 0%,x~2 =1.192;P>0.05),repeat angina(5.6%与 4.8%,x~2 =0.057;P>0.05)and secondary endpoints(3.8%与 4.8%,x~2 =0.105;P>0.05)were not statistically significant between Uygur and Han patients.And in neither ethnic groups,none of sudden cardiac death, stent thrombosis ornonfatal stroke occurred.(2)In the normal metabolizer group,the incidence of repeat acute myocardial infarction(2.3%与 1.4%,x~2 =0.169;P>0.05),repeat angina(5.2%与 5.8%,x~2 =0.010;P>0.05),cardiac death(0.7%与 0%,x~2 =0.534;P>0.05),stent thrombosis(1.6%与 0%,x~2 =1.082;P>0.05)and secondary endpoints( 5.4%与 7.3%,x~2 =0.274; P > 0.05) were not statistically significant between Uygur and Han patients.Conclusion:In Uighur patients who carrying CYP2C19 *2, *3 non-functional allele,150 mg /day clopidogrel therapy may weaken clopidogrel resistance and effectively reduce the incidence of major cardiovascular events, at the same time,it does not increase the risk of bleeding.