A Study On The Prognosis Of Patients With CYP2C19 Slow Metabolism After After Percutaneous Coronary Intervention

Objective:1.To investigate the difference in prognosis after percutaneous coronary intervention between CYP2C19 slow metabolism and Non-CYP2C19 slow metabolism by conventional dual antiplatelet drugs.2.To explore the difference in prognosis after percutaneous coronary intervention in patients with CYP2C19 slow metabolism with the new dual antiplatelet drug treatment regimen and conventional dual antiplatelet drug therapy.Methods:1.According to the inclusion criteria and exclusion criteria to select 2017 jan 01 solstice December 31,2017 in the shandong yantai yu huang ding hospital cardiovascular internal medicine and diagnosis of acute coronary syndrome(ACS)and suffer Percutaneous coronary intervention(PCI)of 221 cases hospitalized patients.1.1 inclusion criteria:(1)a clear diagnosis of acute coronary syndrome(including unstable angina,ST elevation myocardial infarction,non ST-elevation myocardial infarction)and suffer coronary artery interventional therapy and long-term use of dual antiplatelet drug treatment of patients;(2)the diagnosis was mainly based on typical angina symptoms,ecg changes,measurement of myocardial necrotic markers and percutaneous coronary intervention.1.2 exclusion criteria:(1)there has been active bleeding recently、Bleeding tendency and Recently underwent surgery.(2)allergic to aspirin,clopidogrel and tiglielo;(3)severe liver and kidney function damage(transaminase is more than 3 times normal and blood creatinine is greater than 177);(4)there is significant sinus bradycardia or the presence of atrioventricular block of two degrees or more;(5)life expectancy is less than 9 months;(6)the researchers believe that there are other reasons not suitable for this experiment.2.According to the detection of serum CYP2C19 genotype in the patient group:CYP2C19 slow metabolic group(CYP2C19 *2/*2、CYP2C19 *3/*3、CYP2C19 *2/*3)73people;Non-CYP2C19 slow metabolism group(including CYP2C19 *1/*2、CYP2C19*1/*3、CYP2C19 *1/*1)148 people;The patients with CYP2C19 slow metabolism were randomly divided into two subgroups:A group was given routine dual antiplatelet therapy(Aspirin 100mg/qd+ clopidogrel 75mg/qd)、Another group was given a new type of dual antiplatelet drug therapy(Aspirin 100mg/qd+ tiglio 90mg/bid);Non-CYP2C19 slow metabolic patients were treated with conventional dual antiplatelet agents(Aspirin100mg/qd+ clopidogrel 75mg/qd).3.Baseline data were collected from two groups of patients(Including general information:gender、age;Previous history:history of hypertension、history of diabetes、history of cerebrovascular disease;Auxiliary examination Results: Alanine aminotransferase 、Glutamate transaminase 、creatinine、uric acid 、 blood glucose、triglyceride and cholesterol;Personal history:smoking history、drinking history;Coronary angiography data: number of diseased vessels、number of stent implantation.)4.The main adverse cardiovascular events(MACE)in patients with CYP2C19 and non-CYP2C19 were followed by telephone : Recurrent angina,cardiogenic death,nonfatal myocardial infarction.The follow-up period was 3 months.5.Statistical processing: SPSS19.0 software package was used for analysis.The mean value of the measurement data was obtained by means of the mean number plus or minus standard deviation.The counting data was expressed as a percentage,P < 0.05 was considered to be statistically significant.Results:1.Two groups were treated with conventional dual antiplatelet drugs(aspirin100mg/qd+ clopidogrel 75mg/qd):The patients with CYP2C19 slow metabolism group were significantly more likely to have adverse cardiovascular events and bleeding risk than those of the non-CYP2C19 slow metabolism group:In CYP2C19 slow metabolism group,6 of the 42 patients(14.2%)experienced MACE events;However,12 out of 148 patients with non-CYP2C19 slow metabolism group were experienced with MACE(8.3%),and the difference was statistically significant(P<0.05).2.For the conventional dual antiplatelet drug treatment of CYP2C19 slow metabolism group of patients with a new type of dual antiplatelet drug treatment of CYP2C19 slow metabolism group patients whose prognosis of 3 months and bleeding risk of major adverse cardiac events were significantly increased:A group of 42 patients in the CYP2C19 slow metabolism group with conventional treatment regimens experienced MACE events in 6(14.2%)patients;One of the 31 patients in the CYP2C19 slow metabolism of the new treatment regimens(3.6%)experienced MACE events,and the difference was statistically significant.Conclusion:Based on PCI postoperative patients with clinically CYP2C19 gene polymorphisms to early detection,early screening drugs slow metabolism in patients with type,and according to its different genetic polymorphism loci to reasonable optimal regimen,personalized treatment options.In this study,it is in giving CYP2C19 slow metabolism of patients with conventional dual antiplatelet therapy is not slow in the prognosis of patients with metabolic group is a bit poor,hints for each patient clinical individualized treatment as far as possible in order to maximize your earnings.For,on the other hand,Ticagrelor as a new type of oral reversible P2Y12 ADP receptor inhibitor,quick and significant effect of antiplatelet,in this study also prompted to choose a new dual antiplatelet drug treatment group patients clinical benefit more,this prompted us to further use of genetic testing techniques can find more medication,avoid risk as much as possible for patients,and improve earnings.