Efficacy And Safety Analysis Of Different DAPT Regimens For Patients With Rapid Metabolism Of CYP2C19 Genotype After PCI

Objective:To investigate the efficacy and safety of different P2Y12 receptor inhibitors combined with aspirin for patients with rapid-metabolized CYP2C19genotype after percutaneous coronary intervention(PCI).To investigate the efficacy and safety of different P2Y12 receptor inhibitors combined with aspirin for patients with acute coronary syndrome(ACS)and with rapid metabolism of CYP2C19 genotype after percutaneous coronary intervention(PCI).MethodsA total of 582 patients with acute coronary syndrome,who intended to receive PCI treatment and whose CYP2C19 genotype was detected to be rapid metabolized by CYP2C19 gene polymorphism,admitted to the Department of Cardiology,Zhengzhou University First Affliated Hospital from September 2018 to May 2019 were selected.Patients who refused to sign the informed consent,complicated with malignant tumor,combined use of anticoagulant drugs,with hypohepatia,renal insufficiency,subjective change the treatment plan,loss of follow-up and so on were excluded from this study,and 247 patients were finally enrolled.Patients were divided into clopidogrel and aspirin combined with pantoprazole group(referred to as clopidogrel group)(n=91),ticagrelor and aspirin combined with pantoprazole group(referred to as ticagrelor group)(n=87),clopidogrel and aspirin group(referred to as control group)(n=69).The patients in all three groups were given a 300 mg aspirin enteric-coated tablet load before PCI,and the aspirin enteric-coated tablets 100 mg/d long-term maintenance treatment was given after surgery.The difference was that,in the clopidogrel group and the control group,patients were given clopidogrel hydrogen sulfate tablets 450 mg load before the surgery,and the postoperative clopidogrel hydrogen sulfate 75 mg/d was maintained until 1 year after the surgery;in the ticagrelor group,the patients were given a 180 mg ticagrelor load before the surgery,and the ticagrelor 180 mg/d(90 mg in the morning and evening each)was maintained until 1 year after the surgery;in the clopidogrel group and the ticagrelor group,patients were given pantoprazole enteric-coated capsules 40 mg/qd before the surgery until 3 months after the surgery.To observe and compare the differences in platelet inhibition rate 1 week after PCI and the major cardiovascular events,bleeding events and adverse reactions 1 month,3 months and 6 months after PCI.Results(1)There was no significant difference in general clinical data of patients among the three groups(P>0.05).(2)There was no statistically significant difference between clopidogrel group and tigrillo group,clopidogrel group and control group in the platelet inhibition rate ADP(ineffective rate,effective rate,and significant effective rate)of patients 1 week after PCI(P>0.05).(3)There was no significant difference in cardiovascular adverse events between the clopidogrel group and the control group at 1 and 3 months after.PCI(P>0.05).(4)There was a statistically significant difference in the cumulative gastrointestinal bleeding events between the control group and the clopidogrel group 3 months after PCI(P<0.05).(5)There was no significant difference in cardiovascular adverse events between the clopidogrel group and the ticagrelor group at 1 month,3 months and 6 months after PCI(P>0.05).(6)There was no statistically significant difference in the risk of major bleeding events between the clopidogrel group and the ticagrelor group at 1 month,3 months and 6 months after PCI(P>0.05).(7)There was statistically significant difference in the cumulative non-major bleeding events between the ticagrelor and clopidogrel groups at 6 months after PCI(P<0.05).(8)Patients in ticagrelor group were prone to have chest tightness,shortness of breath and other respiratory systems adverse reactions during medication.Conclusions(1)For patients with rapid t metabolism of CYP2C19 genotype after PCI treatment,clopidogrel combined with pantoprazole can reduce the risk of gastrointestinal bleeding,and the efficacy of antiplatelet aggregation therapy is not affected.(2)For patients with rapid metabolism of CYP2C19 genotype after PCI treatment,the clinical benefit of the treatment regimen of clopidogrel combined with aspirin and the treatment regimen of ticagrelor combined with aspirin are consistent.(3)Compared with clopidogrel combined with aspirin,ticagrelor combined with aspirin has a higher risk of non-major bleeding.The use of ticagrelor antiplatelet therapy should be alert to the occurrence of bleeding events.(4)The incidence of symptoms such as dyspnea when using ticagrelor is significantly higher than using clopidogrel,and there is an inherent risk of affecting patients taking medication.