Impact of CYP2C19 genotypes on antiplatelet therapy among Chinese patients with acute myocardial infarction after percutaneous coronary intervention / 中华心血管病杂志

ABSTRACT

Objective@#To investigate the impact of CYP2C19 genetic variants on antiplatelet therapy in Chinese patients with acute myocardial infarction(AMI) after primary percutaneous coronary intervention(PCI), and compare the antiplatelet effect between clopidogrel and ticagrelor with various CYP2C19 genotypes.@*Methods@#From June 2014 to May 2015, 347 patients with AMI who underwent PCI treatment at Fuwai Hospital were enrolled in this single center prospective study, 221 cases were in clopidogrel group and 126 patients were in ticagrelor group.Two candidate single nucleotide polymorphisms (SNPs) (636 and 681 loci) of CYP2C19 gene were detected by polymerase chain reaction—restriction endonuclease method.Adenosine diphosphate (ADP)-induced platelet aggregation was measured by thromboelastography (TEG) at 24-48 hours after primary PCI.@*Results@#There were 93 non-carriers (42.1%, 93/221), and 128 carriers (57.9%, 128/221) in clopidogrel group. There were 48 non-carriers (38.1%, 48/126), 78 carriers (61.9%, 78/126) in ticagrelor group. CYP2C19 genotype frequency was similar between two groups. TEGADP was significantly lower in clopidogrel group than in ticagrelor group (63.08±27.78 vs. 78.08±25.62, P<0.001), both for non-carriers (68.16±25.17 vs. 82.79±22.45, P=0.002) and for carriers (59.37±29.06 vs. 75.15±27.15, P<0.001). TEGADP was significantly higher in non-carriers than in carriers in clopidogrel group (P=0.02) and similar between non-carriers and carriers in ticagrelor group (P>0.05).@*Conclusion@#The CYP2C19 gene mutation is high in the patients with AMI.The effect of antiplatelet of ticagrelor is stronger than clopidogrel, and this effect is not affected by CYP2C19 gene mutations.