Effect Of CYP2C19 Genotype Guided Individualized Medication On Prognosis In Patients With PCI

Objective:Some patients with coronary heart disease(CHD)still have a poor prognosis after percotaneous coronary intervention(PCI)after regular use of antiplatelet drugs.This study analyzes the effect of individualized antiplatelet therapy based on the genotype of cytochrome P4502C19(CYP2C19)on the prognosis of patients with PCI,and provides support for individualized medication after PCI,so as to improve the rate of chest pain relief and nitroglycerin use in patients,and reduce major adverse cardiovascular events.MACE)with the aim of improving clinical prognosis in patients with PCI.Methods:From September 2021 to June 2022,183 PCI patients who underwent CYP2C19 gene testing during inpatient treatment in the Department of Cardiology of the Affiliated Hospital of Yan’an University(Yan’an Group Hospital)were set as the experimental group,and 253 PCI patients who did not undergo CYP2C19 gene testing during the same time period were set as the control group.436 patients in the experimental group and control group were used as the research subjects of this trial,and the study subjects were selected according to the inclusion criteria.Patients in the experimental group were individualized according to the results of genetic testing,and the control group was treated with routine clinical drugs.The basic clinical data and laboratory indicators such as CYP2C19 genotype of 436 subjects were obtained.Through active follow-up,the out-of-hospital situation of the study subjects within six months after PCI surgery was obtained,including chest pain relief rate,nitroglycerin use reduction rate,MACE incidence and overall bleeding within six months.Patients in the experimental group were divided into fast metabolite,normal metabolite,medium metabolite and slow metabolite according to the genetic test results.The genetic test results of the patients in the experimental group were analyzed to obtain the distribution of CYP2C19 genotype and the gene frequency of each allele of CYP2C19.The rate of chest pain relief,reduction rate of nitroglycerin use,incidence of MACE and overall bleeding in the experimental group and the control group were compared within six months.The rate of chest pain relief,reduction rate of nitroglycerin use,incidence of MACE and overall bleeding in the fast metabolite,normal metabolite,medium metabolite and slow metabolite group were compared within half a year.The rate of chest pain relief,the reduction rate of nitroglycerin use,the incidence of MACE and the overall bleeding within six months in the experimental group and the control group were compared.Analyze the factors that affect the occurrence of MACE.SPSS 26.0 software was used for statistical analysis.Normally distributed metrics are expressed as mean ±standard deviation(mean ± SD),and independent sample t-tests are used for between-group comparisons.The rate of counting data(%)indicated that the chi-square test was used for comparison between groups,and the difference was statistically significant with P<0.05.The overall effect of ordered categorical variables is reflected by the average degree,and the rank sum test is used.the difference was statistically significant with z>1.96,P<0.05.Multiple comparisons between multiple sample rates use chi-square segmentation,and the test level must be reestimated.The influencing factors of dichotomous variables were analyzed by binary logistic regression,and the difference was statistically significant with P<0.05.Results:1.The CYP2C19 genotypes of patients in the experimental group included CYP2C19*1/*17,CYP2C19*1/*1,CYP2C19*1/*2,CYP2C19*1/*3,CYP2C19*2/*2 and CYP2C19*2/*3,and the proportions of each genotype were 3.3%,47%,32.8%,8.2%,7.1%and 1.6%,respectively.Alleles include CYP2C 19*1,CYP2C 19*2,CYP2C19*3,CYP2C19*17,and the gene frequencies of each allele are 69.1%,24.3%,4.9%,and 1.6%,respectively.2.Compared with the control group,the patients in the experimental group had a higher remission rate of chest pain,a higher reduction rate of nitroglycerin use,and a lower incidence of MACE,and there was no difference in the overall bleeding between the experimental group and the control group.3.There was no difference in the rate of chest pain relief and the reduction rate of nitroglycerin use in patients in the fast metabolite group,normal metabolic group,medium metabolic group and slow metabolic group in the experimental group,and the incidence of MACE in the four groups was different.The incidence of MACE in the four groups was compared in pairs,and the incidence of MACE in patients in the normal metabolic group was lower than in the slow metabolic group,and there was no difference in the incidence of MACE between the remaining two groups.There was no difference in overall bleeding in patients with fast,normal,intermediate,and slow metabolizers.4.Patients in the fast metabolite group and the normal metabolite group took clopidogrel at the same dose as the control group,and the incidence of MACE was lower than that of the control group,and there was no difference in overall bleeding from the control group.Patients in the moderate and slow metabolite groups who took double doses of clopidogrel had higher rates of chest pain relief and reduction in nitroglycerin use than those in the control group,and there was no difference in overall bleeding from the control group.5.The higher glycated hemoglobin and LDL cholesterol,the greater the likelihood of MACE;Patients with a history of hypertension and diabetes are more likely to develop MACE than those without a history.Conclusion:1.The CYP2C19 genotype of PCI patients in Yan’an City was mainly CYP2C19*1/*1,and the allele was mainly CYP2C19*1.2.Individualized antiplatelet therapy based on CYP2C19 genotype can improve the antiplatelet efficacy and improve the prognosis of PCI patients without increasing the risk of bleeding compared with conventional empirical therapy.3.The incidence of MACE in patients with different metabolic rates CYP2C19 genotypes was different,and there was no difference in overall bleeding.4.Patients carrying CYP2C19 fast metabolism and normal metabolic type taking the same dose of clopidogrel as the control group,and patients carrying CYP2C19 medium metabolism and slow metabolism taking double doses of clopidogrel,the prognosis was better than that of the control group.5.Glycated hemoglobin,LDL cholesterol,diabetes history and hypertension history are risk factors for MACE.