EFFECT OF CLOPIDOGREL OR TICAGRELOR ON PCI PLATELET INHIBITION RATE IN PATIENTS WITH DIFFERENT CYP2C19 ALLELES

Zhen Jiang*, Sai Li*, #, Yinjun Li**, Xiaoyu Jin**, Bo Bao**, Yang Wang**

*Department of Cardiovascular Medicine, The 4th People's Hospital of Shenyang, Shenyang, PR China - **Department of 1 Cardiology, The 4th People's Hospital of Shenyang, Shenyang, PR China

Objective: To investigate the effect of clopidogrel or ticagrelor on PCI platelet inhibition rate in patients with different CYP2C19 alleles. 

Methods: Three hundred patients with coronary heart disease who underwent percutaneous coronary intervention and CYP2C19 gene polymorphism in the Department of Cardiology, Shenyang Fourth People's Hospital, from January 2017 to June 2018, were selected. They were divided into a clopidogrel group and a ticagrelor group according to the use of antiplatelet drugs, with 150 cases in each group. According to the results of genetic testing, they were divided into extensive metabolilism, intermediate metabolilism and poor metabolilism. The incidence of adverse cardiovascular events and platelet inhibition rates after treatment of different drugs in different metabolomes were detected. Seventy-eight patients with clopidogrel resistance were randomly divided into clopidogrel double-dose group and ticagrelor group, with 39 cases in each group. The incidence of adverse cardiovascular events and platelet inhibition rate were observed. 

Results: The rate of intermediate metabolilism and poor metabolilism platelet inhibition was significantly higher in the ticagrelor group than in the clopidogrel group, while the difference was statistically significant (P<0.01). The incidence of adverse cardiovascular events in the clopidogrel group was 20.69%, which was significantly higher than that in the ticagrelor group (6.90%). Thus, the difference was statistically significant (P<0.05). The incidence of adverse cardiovascular events in the clopidogrel double-dose group was significantly higher than that of the ticagrelor group (P<0.01), while the platelet inhibition rate was significantly lower than that of the ticagrelor group (P<0.01). 

Conclusions: Compared with clopidogrel, ticagrelor could effectively reduce the platelet inhibition rate and adverse cardiovascular events in patients with low metabolites in the CYP2C19 gene, as the effect of ticagrelor in patients with clopidogrel resistance is better.