Effect of CYP2C19 genotype on the outcome of antiplatelet therapy in patients with coronary heart disease after percutaneous coronary inter-vention
Objective To investigate the effect of CYP2C19 genotype on the outcome of antiplatelet therapy in patients with coronary heart disease after percutaneous coronary intervention(PCI).Methods A total of 971 patients with coronary heart disease who underwent PCI in Beijing Royal Integrative Medicine Hospital from June 2018 to June 2021 were selected as the research objects.Antiplatelet therapy was determined according to the genotyping results and clinical characteristics,and the patients were divided into Clopidogrel group(ni=724)and Ticagrelor group(n=247).Patients in Clopidogrel group were treated with Clopidogrel(75 mg)once daily and Aspirin(0.1 g)once daily after surgery,and patients in Ticagrelor group received Ticagrelor(90 mg)twice a day and Aspirin(0.1 g)once daily after surgery.The incidences of bleeding and major adverse cardiovascular events(MACEs)were observed in patients with different genotypes in the two groups.Results The incidence of bleeding in Ticagrelor group was higher than that in Clopidogrel group,and the difference was statistically significant(P＜0.05).There was no significant difference in the incidence of MACEs between the two groups(P＞0.05).In the Clopidogrel group,the total incidence of MACEs in patients with very slow metabolism was higher than those in patients with rapid metabolism and slow metabolism,and the differences were statistically significant(P＜0.0 17).In the Ticagrelor group,the total incidence of bleeding in patients with rapid metabolism was higher than those in patients with slow metabolism and very slow metabolism,and the differences were statistically significant(P＜0.017).Conclusion Clopidogrel and Ticagrelor are equally effective in preventing MACEs after PCI.The efficacy of Clopidogrel in preventing MACEs is lower in patients with very slow CYP2C19 metabolizers.The incidence of bleeding is higher in CYP2C19 rapid metabolizer patients treated with Ticagrelor.Clinical treatment can be individualized according to CYP2C19 genotype to optimize the ef-fect of antiplatelet therapy in patients after PCI.
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