Abstract
Objective: To investigate the following: 1) the association between CYP2C19 variants involved in clopidogrel-mediated platelet effects; 2) the association between CYP2C19 variants involved in clopidogrel-mediated inflammatory, endothelial effects; 3) CYP2C19 variants involved in the risk of major adverse cardiovascular events(MACE). Design and Method: We detected the residual platelet aggregation rate (RPA), maximal aggregation rate (MAR) and the plasma levels of sCD40L, sP-selectin, MMP-9, sVCAM-1 and sE-selectin after 24 hours of PCI in 559 patients undergoing PCI treated with clopidogrel, and followed up for one year for MACE. Results: The levels of RPA, MAR, sE-selectin, sCD40l, sP-selectin, MMP-9 and sVCAM-1 in CYP2C19 intermediate metabolizers (IM), poor metabolizers (PM) or both together patients were higher than those in extensive metabolizers (EM) patients. During one-year follow-up, there were 69 cases (13.3%) suffering MACE. The risk of MACE in CYP2C19 IM + PM patients is 2.664 times higher than that in CYP2C19 EM patients (OR = 2.664(1.397–5.193), P = 0.004). Our results suggest that CYP2C19 metabolizers modulate clopidogrel drug efficacy in coronary heart patients undergoing PCI and further impact on the risk of MACE. Conclusions: Thus it is benefit for coronary heart patients undergoing PCI treated with clopidogrel if carried out individualized treatment according to CYP2C19 metabolizers.
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