ASSOCIATION OF DIFFERENT CYP2C19 GENOTYPES WITH CLOPIDOGREL EFFICACY AND ADVERSE CARDIOVASCULAR EVENTS DURING HOSPITALIZATION IN PATIENTS WITH ACS

Song Yi*,Yan Pan**, Yonggeng Zhang***,#, Dann Yang****

*Department of Cardiovascular Ward, The people’s Hospital of Yichun City, Yichun, PR China - **Department of Operation Room, The People’s hospital of Yichun City, Yichun, PR China - ***Department of Cardiology, The People’s Hospital of Yichun City, Yichun, PR China - ****Department of Infectious Disease, The people’s Hospital of Yichun City, Yichun, PR China

Objective: To analyze the correlation between different CYP2C19 genotypes and the efficacy of clopidogrel and adverse cardiovascular events during hospitalization in patients with acute coronary syndrome (ACS). 

Methods: Two-hundred and eighty-eight patients who underwent percutaneous coronary intervention (PCI) from July 2015 to September 2018 were selected. All patients were subjected to a CYP2C19 gene metabolism test. According to the results, the patients were divided into fast (CYP2C19*1/*1) (112 cases), middle (CYP2C19*1/*2, CYP2C19*1/*3) (142 cases) and slow metabolic (CYP2C19*2/*2/*3, CYP29*3/*3) (34 cases) groups. The clinical data of 3 groups were collected and genotyped by real-time quantitative PCR. The platelet inhibition rate was determined using a TEG coagulation analyzer (5000), and the incidence of adverse cardiovascular events was observed during treatment. 

Results: The CYP2C19 genotype accounted for 38.89%, CYP2C19*1/*2 gene 41.67%, CYP2C19*1/*3 gene 7.64%, CYP2C19*2/*2 gene 9.72%, CYP2C19*2/*3 gene 1.39% and CYP2C19*3/*3 gene 0.35%. The inhibition rate of platelet aggregation in the fast metabolic group was significantly higher than that in moderate and slow metabolic groups (P<0.01). The resistance rate of clopidogrel in the fast metabolic group was significantly lower than that in middle and slow metabolic groups (P<0.01). There was no significant difference in platelet inhibition rate and clopidogrel resistance rate and the slow metabolic group (P>0.05). During hospitalization, 13 cases of heart failure, 8 cases of malignant arrhythmia, 4 cases of stent thrombosis, 9 cases of target vessel revascularization, 5 cases of haemorrhage and 7 cases of death occurred in ACS patients. The incidence of adverse cardiovascular events in the fast metabolic group was significantly higher than that in middle and slow metabolic groups (P<0.05). 

Conclusion: The different CYP2C19 genotypes are related to the clinical efficacy of clopidogrel in the treatment of ACS and the incidence of adverse cardiovascular events. The incidence of a CYP2C19*1/*1 genotype cardiovascular event is higher, providing a certain clinical basis for the clinical diagnosis and treatment of ACS.