Why the study?
The ABCD-GENE score was developed to identify patients at risk for diminished clopidogrel antiplatelet effects after PCI, but required validation for predicting atherothrombotic risk in a diverse, real-world population.
Does an ABCD-GENE score ≥ 10 predict a higher risk of major atherothrombotic events in clopidogrel-treated patients after PCI compared to a score < 10?
Does an ABCD-GENE score ≥ 10 predict a higher risk of major atherothrombotic events in clopidogrel-treated patients after PCI compared to a score < 10?
The ABCD-GENE score successfully identifies post-PCI patients on clopidogrel who are at significantly higher risk for major atherothrombotic events, validating its use in real-world clinical practice.
May aid risk stratification in clopidogrel-treated PCI patients; hypothesis-generating before guiding therapy.
The Age, Body mass index, Chronic kidney disease, Diabetes mellitus, and CYP2C19 GENEtic variants (ABCD-GENE) score was developed to identify patients at risk for diminished antiplatelet effects with clopidogrel after percutaneous coronary intervention (PCI). The objective of this study was to validate the ability of the ABCD-GENE score to predict the risk for atherothrombotic events in a diverse, real-world population of clopidogrel-treated patients who underwent PCI and received clinical CYP2C19 genotyping to guide antiplatelet therapy. A total of 2,341 adult patients who underwent PCI, were genotyped for CYP2C19, and received treatment with clopidogrel across four institutions were included (mean age 64 ± 12 years, 35% women, and 20% Black). The primary outcome was major atherothrombotic events, defined as the composite of all-cause death, myocardial infarction, ischemic stroke, stent thrombosis, or revascularization for unstable angina within 12 months following PCI. Major adverse cardiovascular events (MACE), defined as the composite of cardiovascular death, myocardial infarction, ischemic stroke, or stent thrombosis, was assessed as the secondary outcome. Outcomes were compared between patients with an ABCD-GENE score ≥ 10 vs. < 10. The risk of major atherothrombotic events was higher in patients with an ABCD-GENE score ≥ 10 (n = 505) vs. < 10 (n = 1,836; 24.6 vs. 14.7 events per 100 patient-years, adjusted hazard ratio (HR) 1.66, 95% confidence interval (CI), 1.23-2.25, P < 0.001). The risk for MACE was also higher among patients with a score ≥ 10 vs. < 10 (16.7 vs. 10.1 events per 100 patient-years, adjusted HR 1.59, 95% CI 1.11-2.30, P = 0.013). Our diverse, real-world data demonstrate diminished clopidogrel effectiveness in post-PCI patients with an ABCD-GENE score ≥ 10.
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Thomas et al. (2022) studied this question.
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