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To investigate the impact of CYP2C19 metabolizers on clopidogrel-mediated platelet, inflammatory, endothelial effects and the risk prediction of major adverse cardiovascular events (MACE) in coronary heart patients undergoing percutaneous coronary intervention (PCI).
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. 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.
Thus it is benefit for coronary heart patients undergoing PCI treated with clopidogrel if carried out individualized treatment according to CYP2C19 metabolizers.