Objective To observe the clinical efficacy of CYP2C19 genotype detection guided antiplatelet therapy in patients with ischemic stroke (IS) and its effect on adverse cardiovascular and cerebrovascular events (MACCE).
Methods A total of 130 IS patients were selected in this study, and were divided into control group (n=65) and observation group (n=65) by random number table method. Patients in the control group were given aspirin and clopidogrel regimen, those in the observation group were firstly tested for CYP2C19 genotypes, and were further divided into fast metabolism (CYP2C19*1/*1) group(n=30), medium metabolism (CYP2C19*1/*2, CYP2C19*1/*3) group(n=20) and slow metabolism (CYP2C19*2/*2, CYP2C19*3/*3, CYP2C19*2/*3) group(n=15)based on the test results. Patients in the fast metabolism group were treated with clopidogrel, those in the middle metabolism were still treated with clopidogrel, and those in the slow metabolism group were given aspirin treatment at the first day of treatment. All patients were followed up for 1 year. According to the occurrence of MACCE, the patients were divided into MACCE group(n=28) and non-MACCE group(n=102). Platelet aggregation was compared between the control group and the observation group. Modified RANKIN Scale (mRS) scores and the incidence of MACCE were compared between control group and observation group. Univariate analysis was used to explore difference of clinical data between MACCE group and non-MACCE group; independent risk factors for the prognosis of MACCE in patients with IS were analyzed by multiple Logistic regression analysis.
Results After 1 month of treatment, the platelet aggregation rates in the control group and observation group were lower than before treatment, the platelet aggregation rates in the fast metabolism group and middle metabolism group were lower than that in the control group, and the platelet inhibition rates in fast metabolism group and middle metabolism group were higher than that in control group (P < 0.05). There was no significant difference between the slow metabolism group and the control group in platelet aggregation rate and platelet inhibition rate (P>0.05). After 1 month of treatment, the mRS scores of both groups were significantly decreased, and the observation group was lower than the control group (P < 0.05). The incidence of MACCE in the observation group was significantly lower than that in control group (P < 0.05). The incidence rates of MACCE in the fast metabolism group and middle metabolism group were lower than those in the control group, and the incidence of MACCE in the middle metabolism group was the lowest(P < 0.05). Logistic regression model showed that older age, hypertension, diabetes and left ventricular ejection fraction(LVEF) < 50% were independent risk factors for MACCE in IS patients (P < 0.05).
Conclusion For patients with IS, CYP2C19 genotype detection and corresponding treatment for patients with different subtypes can effectively improve their platelet aggregation rate and inhibition rate, and reduce the occurrence of MACEE, especially for patients with CYP2C19*1/*2 and CYP2C19*1/*3 types of medium metabolism who have the highest benefits. Independent risk factors for MACEE in patients with IS include older age, hypertension, diabetes and LVEF < 50%. Close clinical monitoring should be conducted to improve the prognosis of these patients.
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