The Correlation Research Of Thrombosis Elastic Graph And CYP2C19 Genotype After Emergency Percutaneous Coronary Intervention In Acute Myocardial Infarction

Objective:By studying the taiyuan area percutaneous emergency coronary intervention treatment of postoperative thrombosis elastic graph and drug metabolism enzymes cytochrome P450 system CYP2C19 genotype, further guide the antithrombotic therapy.Methods:Choice in August 2015 to March 2016 in Shanxi Province hospital emergency PCI perioperative cardiovascular disease in patients with acute myocardial infarction(60 cases,both aspirin and clopidogrel dual antiplatelet medications.60 patients, 50 cases of male,female 10 cases, with an average age of 62.11(7.95 mm), ranging in age from 42 to 78 years.All patients admitted to hospital after 4 days morning when collecting venous blood,improve the detection of adenosine diphosphate(ADP) induced platelet aggregation inhibition rate, on the basis of the determination results are divided into clopidogrel sensitive group with clopidogrel resistance.Detection of 60 cases of patients with acute myocardial infarction(CYP2C19 genotype, according to the features of different allele gene is missing, divided into slow metabolism genotype, intermediary metabolism genotype and fast metabolism genotype.Further comparison of clopidogrel resistance and clopidogrel sensitive group of patients in general clinical data, the difference of CYP2C19 genotype and biochemical indicators.Using SPSS18 statistics software to carry on the analysis, to study clopidogrel resistance and the correlation between CYP2C19 gene polymorphisms.Results:60 cases treated with emergency PCI in patients with acute myocardial infarction(mi)50 cases(83.33%) of the men and women in 10 cases(16.67%), aged 37-87, the average age(59.39-9.32).Clopidogrel sensitive group of 32 cases(53.33%), platelet inhibition rate was(75.77 + 12.75) %.Clopidogrel resistance group of 28 cases(46.67%), platelet inhibition rate was(30.93 + 15.42) %.60 cases of patients with acute myocardial infarction(mi), check out the CYP2C19 genotype for fast metabolism genes among 20 cases(33.33%) metabolic type 27 cases(45%), slow metabolism genotype in 13 cases(21.67%).Fast slow metabolism, intermediary metabolism and metabolic platelet inhibition of three groups respectively((74.59 + 17.35) %,(49.06 + 11.53) % and(22.71 + 20.05) %.Clopidogrel resistance in intermediary metabolism, metabolic type fast and slow metabolism between three groups with statistical significance(P < 0.01). On the basis of ROC curve to calculate the prediction of CYP2C19 genotype best bound value of platelet aggregation rate(the cut- off value) of 39%. The best threshold experiment, the diagnosis results indicate the sensitivity of the CYP2C19 genotype for slow metabolism genes,specific degree, positive predictive value, negative predictive value were 95.6%, 93.3%,97.7% and 93.3% respectively. Results suggest when platelet aggregation inhibition rate less than 39%, a 97.7% chance of genotype is slow metabolism model.Conclusions:1. Can be applied to thrombus elastic figure of PCI postoperative patients with acute myocardial infarction gene prediction.Thus taking individualized antiplatelet therapy to reduce the incidence of stent thrombosis.2. Can be further defined through genetic testing technology patients CYP2C19 genotype, adjustment and early antiplatelet therapies.