Analysis The Effect Of Gene And Platelet Testing Guide Dual Anti-upgrade Therapy After PCI In Patients With ACS

Objective: To analyze whether the gene and platelet testing guidance ACS patients PCI benefit from postoperative dual antiplatelet escalation therapy.Methods: Selecting ACS patients with 209 routine PCI surgery from January 2018 to January 2019 in Department of Cardiology,Third Affiliated Hospital of Guangzhou Medical University.Preoperative administration of aspirin 300 mg and clopidogrel 600 mg,and continued administration of clopidogrel 75mg/d and aspirin 100mg/d after operation.The genotype of CYP2C19 was detected by gene chip 24 h after operation.One genotype was excluded from CYP2C19*1/*17 patients.According to genotype the remaining patients were divided into non loss of function(Non-LOF)alleles group Extensive-metabolisms(EMs)type(CYP2C19*1/*1),loss of function(LOF)alleles group as Intermediate metabolic(IMs)type(CYP2C19*1/*2,CYP2C19*1/*3)and Poor-metabolisms(PMs)type(CYP2C19*2/*2,CYP2C19*2/*3,CYP2C19*3/*3).Using light transmittance aggregation(LTA)to detect platelet aggregation rate and then define the maximum platelet aggregation rate(MPA)?46% as hyperplatelet reactivity(HPR).23 patients with HPR and continue with clopidogrel in the LOF group who were upgraded to ticagrelor for continuous treatment were included in the LOF upgrade group.The remaining patients who did not have HPR and continued to be treated with clopidogrel comprised 90 patients in the LOF unupgraded group and 95 patients in the non-lof group who continued to be treated with clopidogrel.The major adverse cardiovascular events(MACE)were recorded for 1 year follow-up,and the incidence of MACE in the three groups was compared to determine whether gene and platelet detection guidance ACS patients benefited from postoperative dual antiplatelet escalation therapy.Results:(1)208 patients were divided into 95 cases with Extensive-metabolisms type(EMs)(45.7%),88 cases with Intermediate metabolic type(IMs)(42.3%)and 25 cases with Poor-metabolisms type(PMs)(12.0%)according to genotype.(2)Maximum plateletaggregation rate in EMs,IMs and PMs:(27.70±18.15)vs(28.96±17.13)vs(38.64±15.90),of with only EMs having a difference with PMs(P<0.05).A total of 44 patients with HPR were detected,among them,EMs 21 cases,IMs 18 cases,PMs 5 cases,and there was no significant difference in the incidence of three metabolic types(P>0.05).(3)There was no significant difference in clinical data between the Non-LOF group,the LOF unupgraded group and the LOF upgraded group according to the results of gene and platelet detection and clinical drug use(P>0.05).(4)There were 26 cases occurred during follow-up MACE,among which the incidence of unstable angina recurrence and overall MACE in the LOF un upgrade group was the highest and significantly different compared with the Non-LOF group(P<0.05),there was no significant difference compared with the LOF upgrade group(P>0.05).There was no significant difference in the incidence MACE Non-LOF compared with the LOF upgrade group(P>0.05)and no significant difference in bleeding risk(P>0.05).Conclusion: 1.High incidence of CYP2C19 LOF genes in Guangzhou population 2.Poor-metabolisms type(PMs)among the three metabolic types have obvious effects on platelet aggregation rate,suggesting that genes are important factors for differences in platelet reactivity.3.Deletion genes are associated with MACE development,there is no benefit in upgrading treatment for high-risk patients screened for gene and platelet testing.