The Value Of CYP2C19 Gene Detection For Coronary Heart Disease Patients With Clopidogrel Therapy

Objective: To investigate the relationship between CYP2C19 gene polymorphism and clinical efficacy of clopidogrel in patients with coronary artery disease(CAD).Methods: A total of 260 patients with coronary artery disease were enrolled,including 160 patients after PCI and 100 patients with multivesseldisease by selective coronary angiography(SCA)that neither be treated with PCI or received coronary artery bypass(CABG).According to CYP2C19 gene detection,the patients were divided into 3 groups.The patients who were fast metabolism received clopidogrel 75mg/day(n=122).Patients with medium and slow metabolism were further divided into 2 groups as normal dosage group who received clopidogrel 75 mg/day(n=86)and high dosage group who received clopidogrel150 mg/day(n=52).All patients were observed the drug use out-of-hospital(including nitrates,betablockers,nicorandil,trimetazidine,ACEI/ARB,calciumantagonists,statins,etc).MACE incidence(including cardiac death,non-fatal myocardial infarction,stent thrombosis),bleeding condition(including gums and oral mucosal bleeding,hematuria,gastrointestinal bleeding and cerebral hemorrhage),vascular reconstruction and recurrent angina.Results: 1.Using of nitrates,ACEI /(ARB),?-blockers were similar between fast metabolism group and high-dose group.But it was higher in medium-slow metabolism group with routine dose clopidogrel.Using of nicorandil,trimetazidine,calcium antagonist and statin were similar among three groups.2.The incidence of non-fatal myocardial infarction was similar between fast metabolism group and high-dose group and higher in medium-slow metabolism group with routine dose clopidogrel.The incidence of stent thrombosis was similar among three groups.3.Bleeding condition was similar among three groups.4.The incidence of recurrent angina was similar between fast metabolism group and high-dose group.While compared with fast metabolism group and high-dose group,the incidence of recurrent angina was higher in medium-slow metabolism with routine dose clopidogrel.The occurrence of vascular reconstruction was similar among three groups.5.Multivariate logistic regression analysis showed that CYP2C19*2 genotype,hypertension and diabetes were risk factors of MACE(OR=2.641,95% CI:1.267~5.504;OR=2.217,95%CI:1.088~4.515;OR=2.950,95% CI:1.466~5.938).Conclusion: CYP2C19 gene polymorphism was associated with the incidence of recurrent angina,non-fatal myocardial infarction and drug use out-of-hospital in patients with PCI and multivessel disease.CYP2C19*2 was one of the related risk factors of MACE.CYP2C19 gene polymorphism detection is valuable to guide clinical anti-platelet therapy.