Dual Antiplatelet Therapy In Post Percutaneous Coronary Intervention Patients To Reduce The Event Of Coronary Stent Thrombosis:A Comparative Study Of Gene Test And Thromboelastography

Purpose: This study was about the TEG and the genetic test(CYP2C19)in evaluating the value of clopidogrel in the assessment of dual antiplatelet therapy after PCIMethods: The study was approved by the ethics committee of the Zhongda Hospital affiliated to Southeast University.In total 100 coronary artery disease patients who had undergone successful PCI with stent implantation were included in this study.Patients were treated with dual anti-platelet therapy(aspirin and clopidogrel).Genotypes of cytochrome P450(CYP)2C19 polymorphism were determined,thromboelastography analysis reports were collected.Statistical analysis was performed using SPSS software(SPSS 20.0 SPSS Inc.,Chicago,IL,USA)and Pearson chi-square(X2)was used for categorical variables.All subjects were followed through 8 months.RESULTS: A total of 100 coronary artery disease patients successfully undergone PCI stent implantation were considered,of which 28 patients were excluded because clopidogrel was changed to ticagrelor before hospital discharge;finally 72 patients(n=72)meeting all our study criteria were included.We established two groups according to the test requirements,the group 1 made of patients who underwent genetic test,and the group 2 were made of patients who underwent thromboelastography both after being on dual antiplatelet medications;during 8month of the follow-up period,we noticed that among the 21 patients with positive TEG test,15 patients had recurrent episodes of chest discomfort,After providing informed consent,only 10 patients agreed for evaluation of their coronary artery via coronary angiography which showed LAD in-stent stenosis,their medication was switched to ticagrelor+aspirin after the coronary angiography;there was no episode of ischemic events among the 33 patients with positive CYP2C19 genetic test,and finally among the 18 patients with negative results from TEG analysis and CYP2C19 genetic test,we noticed that their daily medications was switched to ticagrelor plus aspirin 2 months after hospital discharge.After statistical analysis of both groups our results showed that there was a statistical significant difference between thromboelastography and gene test(P =0.01),suggesting that CYP2C19 and TEG could both be promising tool to evaluate the risk of clinical event on post PCI patients.Conclusion: According to our results the genetic test and TEG seems to be two promising tools to evaluate the risk of clinical event on the post percutaneous coronary intervention patients on dual antiplatelet therapy;also this study helps us to increase the basic understanding about genetic test as a useful method to determine the event of in-stent stenosis in post-PCI patient using dual antiplatelet therapy,which will hopefully lead to further optimization of predicting the events of coronary in-stents stenosis...