Clinical Study On CYP2C19 Gene Polymorphism Guiding Individualized Anti-platelet Therapy For Coronary Heart Disease Patients After PCI

Objectives:Through investigating whether anti-platelet therapy was guided according to CYP2C19 gene detection results in patients with coronary heart disease after PCI,and comparing the anti-platelet efficacy and occurrence of adverse cardiovascular events under different treatment schemes.And the application value of CYP2C19 gene detection in individualized anti-platelet therapy for patients with coronary heart disease after PCI was discussed.Methods:From June 2018 to March 2019,299 newly diagnosed hospitalized patients with coronary heart disease who successfully completed PCI were selected.Platelet aggregation rate was detected by turbidimetry(ADP induction)and CYP2C19 gene polymorphism was detected by PCR-gene chip hybridization.The anti-platelet treatment plan and readmission information due to cardiovascular events within 1 year after PCI and discharge during the initial hospitalization were recorded.The distribution of CYP2C19 alleles,genotypes and metabolic types were calculated by gene frequency method.When the treatment scheme recommended by the gene test results was consistent with the actual treatment scheme,it was recorded as group A,and if it was inconsistent,it was recorded as group B.To analyze the correlation between A,B and CYP2C19 metabolic type,and compare the platelet aggregation rate before and after anti-platelet therapy between group A and B and whether there was statistically significant difference in readmission due to adverse cardiovascular events within one year after discharge between A and B.Results:Among 299 patients with coronary heart disease after PCI,CYP2C19*1/*1 accounted for 42.81%,and*1/*2 accounted for 41.14%.Patients with CYP2C19 moderate metabolism(46.15%)and slow metabolism(11.04%)accounted for 57.19%.79.69%of normal metabolic patients and 66.67%of slow metabolic patients were divided into group A(60.87%),57.97%of moderate metabolic patients were divided into group B(39.13%),CYP2C19 metabolic type had obvious correlation with A and B(P=0.000).The platelet aggregation rate before anti-platelet therapy had no correlation respectively with CYP2C19 gene polymorphism,gender and age(P>0.05).Before anti-platelet therapy,there were no significant difference in platelet aggregation rate between A and B(P>0.05).After anti-platelet therapy,the platelet aggregation rate in group A were significantly lower than that in group B,and the difference were statistically significant(P=0.001).The platelet aggregation rate of group A after anti-platelet treatment were significantly lower than that before treatment,and the difference was statistically significant(P=0.000),while group B had no significant difference(P=0.683).There were no significant difference in the readmission rate of group A and group B due to adverse cardiovascular events within one year after discharge(P=0.820),but the occurrence rate of major adverse cardiovascular events in group A were significantly lower than that in group B(P=0.046).Conclusion:1.From the analysis of CYP2C19 genotype and metabolic type proportion,it showed the urgent need for CYP2C19 gene detection in patients with coronary heart disease after PCI.2.The proportion of three metabolic types of CYP2C19 in group A was low,and the compliance of clinicians to CYP2C19 gene guidance was not high.3.The anti-platelet therapy based on CYP2C19 gene can significantly improve the platelet aggregation function of patients with coronary heart disease after PCI and reduce the occurrence of major adverse cardiovascular events.