Analysis on the Application Value of TEG Combined with CYP2C19 Detection Guiding Antiplatelet Therapy in ACS Patients after PCI
Objective To explore the guiding value of thromboelastography (TEG) combined with CYP2C19 detection for antiplatelet therapy after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). Methods 270 ACS patients who planned to undergo PCI treatment at Pingxiang People's Hospital from June 2019 to June 2022 were divided into Group A (without examination,n=88),Group B (CYP2C19 gene testing,n=98),and Group C (TEG combined with CYP2C19 gene testing,n=84) according to the patient's wishes. Group A was treated with aspirin combined with clopidogrel for antiplatelet therapy;Group B was divided into B1 group (normal metabolism) and B2 group (abnormal metabolism) based on the CYP2C19 gene test results,they were treated with aspirin combined with clopidogrel and aspirin combined with ticagrelor,respectively;Group C was divided into C1 group[normal metabolism+normal response to clopidogrel (NCR)],C2 group[normal metabolism+low response to clopidogrel (LCR) or abnormal metabolism+NCR],and C3 group (abnormal metabolism+LCR) based on the CYP2C19 gene and TGE detection results,aspirin combined with clopidogrel,aspirin combined with clopidogrel or ticagrelor,aspirin combined with ticagrelor,and aspirin combined with ticagrelor were administered separately,TEG was tested again after one week of treatment in Group C2,according to the maximum amplitude induced by adenosine diphosphate,the treatment regimen was adjusted;all patients maintained treatment for 1 year. The cardiac function[left ventricular ejection fraction (LVEF),left ventricular end-diastolic diameter (LVEDD)]before and after treatment were compared among the three groups. The incidence of major adverse cardiovascular events (MACE),bleeding events and adverse drug reactions within 1 year after PCI were counted in the three groups. Results After treatment,LVEF increased and LVEDD decreased in all three groups compared to before treatment (P<0.05),but there was no statistical significant difference between the groups (P>0.05).The incidence of MACE in Group C was lower than that in Group B and Group A,and the incidence of MACE in Group B was lower than that in Group A (P<0.05). There was no statistically significant difference in the incidence of bleeding events and adverse reactions among the three groups (P>0.05). Conclusion The combination of TEG and CYP2C19 detection has a high guiding value for antiplatelet therapy in ACS patients after PCI,which can reduce the incidence of MACE without increasing the incidence of bleeding events and adverse reactions.
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