Selection Of Anti-platelet Drug In Patients With Acute Coronary Syndrome(ACS) After Percutaneous Coronary Intervention Guided By CYP2C19

Objectives: To provide references to select antiplatelet drugs and doses for treatment according to the different genotype of patients with acute coronary syndrome(ACS) after PCI,and observe the anti-platelet effect and bleeding risk.Methods: Select 231 patients with ACS after PCI and detect theirCYP2C19 genotype.According to the different genotype, we divide them into fast metabolism group(CYP2C19*1/*1),metabolic group(CYP2C19*1/*2、CYP2C19*1/*3),slow metabolism group(CYP2C19*2/*2、CYP2C19*3/*3、CYP2C19*2/*3),and respectively give conventional dual antiplatelet therapy for fast metabolism group(Clopidogrel 75 mg qd+Aspirin 100 mg qn),double dose of clopidogrelfor metabolic group(Clopidogrel 150 mg qd+Aspirin 100 mg qn),new anti-platelet drugs for slow metabolism group(Ticagrelor90mg bid+Aspirin 100 mg qn).Then,we compare conventional program of each group;use TEGto detect the platelet inhibition rate changes after the new medication program is used for 3 months, follow-up and compare the occurrence of adverse cardiovascular events and bleeding events of each group.Result:In 231 after PCI in the treatment of patients with ACS,with the incidence of missing features alleles was no difference in a previous study,fast metabolic type accounted for 37.66%、intermediary metabolism type accounted for51.08%、slow metabolism type accounted for11.26%. In male, the fast metabolism is 37.89%(61/161)and intermediary metabolism model is 50.93%(82/161), slow metabolism type is 11.18%(18/161). In female, the fast metabolism type is 37.14%(26/70) and intermediary metabolism type is 51.43%(36/70), slow metabolism type is 11.43%(8/70). There was no difference in Gender of patients with ACS of CYP2C19 gene polymorphisms.According to genotype in three groups of clinical baseline data and the result of PCI have not statistical differences.Double clopidogrel group and ticagrelor group patients after three months of platelet inhibition of platelet inhibition rate higher than conventional treatment,ADP is greater than 30%, the difference was statistically significant.Among them,the increase of ADP of ticagrelor group are more obvious than clopidogrel in double dose group.Follow-up for three months, three groups of major adverse cardiovascular events and bleeding events have not statistical difference.Conclusion:After PCI in patients with ACS using conventional dual antiplatelet therapy,carry CYP2C19 * 2、CYP2C19 * 3 function lack allele can affect the antiplatelet effect of clopidogrel。After PCI in patients with ACS,carrying CYP2C19 * 2, CYP2C19 * 3 allele with clopidogrel in patients with clopidogrel in double dose and change for ticagrelor, compared with conventional dual antiplatelet therapy for not carrying CYP2C19 * 2, CYP2C19 * 3 allele, efficacy and safety are the same.Carrying CYP2C19 * 2, CYP2C19 * 3 allele for high-risk patients, in use for ticagrelorto fully inhibit platelet, does not increase the risk of bleeding, reduce MACE occur at the same time,reach low risk level of didn’t carry lack allele of patients。CYP2C19 genotype points for patients with ACS provide reference for the selection of PCI individualized antiplatelet agents.CYP2C19 genotype points for patients with ACS of PCI antiplatelet drug individual choice to provide the reference。...