The Study Of Antiplatelet Individualized Therapy After Percutaneous Coronary Intervention

Objective: To provide a reference for the choice of antiplatelet drugs for the patients who had suffering from acute coronary syndrome(ACS)and been given antiplatelet drugs according to the different genotype of CYP2C19 after percutaneous coronary intervention(PCI)by comparing the platelet reactivity and major adverse cardiac events(MACE)in six months.Methods: We selected 294 patients who had suffering from ACS and been given PCI and detected their CYP2C19 genotype to d ivide them into fast metabolism group(CYP2C19*1/*1),intermediary metabolism group(CYP2C19*1/*2,CYP2C19*1/*3),slow metabolism group(CYP2C19*2/*2,C YP2C19*2/*3,CYP2C19*3/*3)and respectively give fast metabolism group conventional dual antiplatelet therapy(clopidogrel 75 mg qd + aspirin 100 mg qn),intermediary metabolism group double dose of clopidogrel(clopidogrel 150mg+aspirin 100 mg qn)or new antiplatelet drugs(ticagrelor 90 mg bid + aspirin 100 mg qn)and slow metabolism group new antiplatelet drugs(ticagrelor 90 mg bid + aspirin 100 mg qn).We compared the occurrence of MAC E and the changes of platelet inhibition rate after the new medication program is used for six months.Results: There was no difference between the proportion of 294 patients with ACS,which was associated with the deletion of functional alleles(CYP2C19*2,CYP2C19* 3)and the one in previous studies.Fast metabolism type accounted for 42.18%.Intermediary metabolism type accounted for 41.49%.Slow metabolism type accounted for 16.33%.In male,the fast metabolism type is 42.26%(101/239)and intermediary metabolism type is 41.84%(100/239),slow metabolism type is 15.90%(38/239).In female,the fast metabolism type is 41.82%(23/55)and intermediary metabolism type is 40.00%(22/55),slow metabolism type is 18.18%(10/55).There was no statistical difference in the distribution of different sex patients with ACS of CYP2C19 gene polymorphisms(P>0.05).There were no statistical differences in the clinical baseline data and PCI results between the groups which were divided according to the different genotype of CYP2C19 and antiplatelet individualized therapy.After six months,the platelet inhibition rates in these groups(intermediary metabolism group of double dose of clopidogrel,intermediary metabolism group of new antiplatelet drugs and,slow metabolism group of new antiplatelet drugs)increased,each of which was more than 30%,and there was statistical significances among them.Not only the platelet inhibition rate of slow metabolism group of new antiplatelet drugs but also the one of slow metabolism group of new antiplatelet drugs was obviously higher than the one of intermediary metabolism group of double dose of clopidogrel.The occurrence rates of MACE among four groups had no statistical significances.Conclusions: The antiplatelet effect and safety are the same between the high-risk ACS patients with CYP2C19*2 or C YP2C19*3 given double doses of clopidogrel or new antiplatelet drug(ticagrelor)and the patients without C YP2C19*2 and CYP2C19*3 given conventional dual antiplatelet therapy.Giving the high-risk ACS patients with CYP2C19*2 or CYP2C19*3 the new antiplatelet drug can fully inhibit platelet and mak e the platelet inhibit rate reach the level of the low-risk ones.Giving double doses of clopidogrel or new antiplatelet drugs to the patients who are intermediary metabolism group according to their CYP2C19 genotype can effectively inhibit platelet reactivity,and the occurrence of MAC E has no statistical significances.CYP2C19 genotype may provide a reference for the selection of antiplatelet drugs in patients with ACS.Genotyping of CYP2C19 gene CYP2C19 may provide a reference of the selection of antiplatelet drugs for patients with ACS.