Analysis of CYP2C19 gene polymorphism detection in patients with coronary heart disease undergoing percutaneous coronary intervention in Yangzhou region

Objective To investigate the distribution differences of cytochrome P4502C19 (CYP2C19) gene polymorphisms and its impact on antiplatelet therapy in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI) in Yangzhou region.

Methods A total of 215 patients diagnosed with coronary heart disease who underwent PCI from January 2021 to December 2022 in Yangzhou region were retrospectively selected as study objects. The age of the patients ranged from 37 to 93 years, with 152 males and 63 females. Polymerase chain reaction-sequencing was used to detect the CYP2C19 genotypes in the patients. The relationships of gender and age with distribution of CYP2C19 gene polymorphism were observed. Based on the metabolic types of CYP2C19 and the antiplatelet drugs used post-operatively, the patients were divided into fast-metabolizing clopidogrel group, medium-slow metabolizing clopidogrel group, fast-metabolizing ticagrelor group, medium-slow metabolizing ticagrelor group. After 6 months of follow-up, the incidence rates and severity of adverse events of cardiovascular ischemia and bleeding were compared among groups.

Results The CYP2C19 genotypes of 215 patients were distributed as follows: 81 cases of CYP2C19*1/*1 genotype, 93 cases of CYP2C19*1/*2, 10 cases of CYP2C19*1/*3, 25 cases of CYP2C19*2/*2, 6 cases of CYP2C19*2/*3. CYP2C19 metabolite types were fast metabolizers in 81 cases (37.67%), intermediate metabolizers in 103 cases (47.91%) and slow metabolizers in 31 cases (14.42%). The proportion of extensive metabolizers of CYP2C19 in the study patients was 37.67%, intermediate metabolizers accounted for 47.91%, and poor metabolizers accounted for 14.42%. There was no significant difference in the distribution of CYP2C19 genotype between different genders(χ²=0.346, P=0.987). There was no significant difference in the distribution of metabolic type between different genders (χ²=0.342, P=0.843). There was no significant difference in the distribution frequency of metabolic type among different age groups (χ²=1.098, P=0.895). The incidence of cardiovascular ischemia of adverse events in the fast-metabolizing clopidogrel group and the fast-metabolizing ticagrelor group was 16.67% and 14.29%, respectively, no significant difference was observed (P>0.05). The incidence of cardiovascular ischemia of adverse events in the medium-slow metabolized clopidogrel group was higher than that in the medium-slow metabolized ticagrelor group, and the difference was statistically significant (P < 0.05). There was no significant between-group difference in the incidence of bleeding of adverse events among groups(P>0.05).

Conclusion In patients undergoing PCI for coronary heart disease in Yangzhou region, there is a polymorphism in the CYP2C19 gene with no significant differences between genders and age groups. The intermediate and fast metabolizers are more prevalent. It is clinically significant to perform CYP2C19 gene testing and adopt precise antiplatelet therapy for such patients.