A Cohort Study Of Both Polymorphisms And High Platelet Reactivity In Prediction Of Recurrent Events Of AICVD

Objectives To evaluate the role of both CYP2C19 polymorphisms and high platelet reactivity(HPR) to ADP in prediction of recurrent ischemic events in patients with acute ischemic cerebrovascular.Methods From January 2014 to September 2014 single center continuously enrolled acute ischemic cerebrovascular patients and gave them antiplatelet therapy of aspirin with clopidogrel. HPR was detected by thrombelastography(TEG) after 5 days of antiplatelet therapy and CYP2C19 polymorphisms was detected during the hospitalization. Multivariable Logistic regression was used to determine the independently associated factors of HPR. Kaplan-Meier method based on the patients HPR to ADP and CYP2C19 polymorphisms synthesized patients cumulative survival curve, the LSD correction was used for multiple comparisons Recurrent ischemic events were followed up at 3 months and 6 months after hospital discharge, Multivariable Cox regression was used to determine the risk factors of recurrent ischemic events.Results 1 Eligible 374 patients with acute ischemic cerebrovascular disease were enrolled. Through the TEG testing, 63 patients(16.8%) were divided into HPR to ADP group, 18 patients(4.8%) were divided into HPR to AA group and 6 patients(1.6%) were divided into HPR to ADP and AA group. Among them 338 patients completed the CYP2C19 genotype testing, 138 patients(41%) were divided into non-carriers, 200 patients(59%) were divided into carriers of the at least one CYP2C19 reduced-function allele. 2 Multivariable Logistic regression showed that: Hemoglobin(HB)(Odd Ratio(OR)=0.982,95% Confidence Interval(CI): 0.967~0.997, P=0.017) is independently associated factor with HPR to ADP and Platelet count(PLT)(OR=1.007, 95%CI:1.001~1.014, P=0.031) is independently associated factor with HPR to AA. 3 Kaplan-Meier analysis shows that: compared with non-carriers +NPR group or carriers +NPR group, carriers +HPR to ADP group had a higher risk of recurrent ischemic events(P<0.001). Compared with non-carriers +HPR to ADP group, carriers +HPR to ADP group had a higher risk trend of recurrent ischemic events(P=0.06). And compared with non-carriers +NPR group(9.8%) or carriers +NPR group(8.7%) or non-carriers +HPR to ADP group(18.2%), carriers +HPR to ADP group had a higher occurring rate of recurrent ischemic events(36.1%). 4 Multivariable Cox regression showed that: Hypertension(Hazard ratio(HR)=2.82, 95%CI:1.20~6.65, P=0.018), History of stroke(HR=2.15, 95%CI:1.21~3.83, P=0.009), HPR to ADP(HR=2.68,95%CI:1.47~4.88, P=0.001) are independently associated factors with recurrent ischemic events. And carriers of the at least one CYP2C19 reduced-function allele may be related to recurrent ischemic events.Conclusions CYP2C19 polymorphisms may be related to recurrent ischemic events, but a further study is needed. HPR to ADP is an independently associated factor with recurrent ischemic events.