Effect of the CYP2C19, ABCB1 and PON1 gene polymorphisms on the clopidogrel in the treatment of ACS after PCI

ObjectiveTo investigate the effects of the gene polymorphisms of CYP2C19, ABCB1 and PON1 on clopidogrel in the treatment of acute coronary syndromes(ACS) after percutaneous coronary intervention.

MethodsA total of 98 patients treated with dual antiplatelet therapy of aspirin and clopidogrel after PCI were divided into the normal group(172 cases) and slow metabolism group(24 cases) according to the gene detection of CYP2C19, ABCB1 and PON1.The normal group and slow metabolism group were given the routine treatment and ticagrelor instead of control treatment, respectively.The platelet aggregation rates in two groups were measured after 5 days of continuous treatment, and the patients were followed up for 1 year.The major cardiovascular adverse events were recorded in two groups, and the platelet aggregation rates and clinical endpoint events were compared between two groups.

ResultsThe differences of the platelet aggregation rates among the patients with different types of PON1、CYP2C19、ABCBl were statistically significant(P < 0.01).After 1 year of following up, the differences of the clinical endpoint events among the patients with different types of PON1、CYP2C19、ABCBl were not statistically significant(P>0.05).There were 16 cases with adverse cardiovascular events and 4 cases with severe bleeding events in the normal group, while there was not adverse cardiovascular events or severe bleeding events in the slow metabolic group, and the difference of which was not statistically significant(P>0.05).

ConclusionsThe polymorphisms of CYP2C19, ABCB1 and PON1 genes are associated with clopidogrel resistance in CHD patients after PCI.Ticagrelor may have better clinical effectsin patients with slow metabolism.