Efficacy and safety of clopidogrel and ticagrelor in acute coronary syndrome patients with CYP2C19 loss-of-function alleles after percutaneous coronary intervention: based on the Global Registry of Acute Coronary Events score

Background: The selection of P2Y12 inhibitors for acute coronary syndrome patients after percutaneous coronary intervention (PCI) remains controversial among East Asian patients. Objectives: loss-of-function (LOF) alleles based on the Global Registry of Acute Coronary Events (GRACE) score. Methods: Between March 2016 and March 2019, a cohort of 8683 patients diagnosed with acute coronary syndrome who survived PCI were enrolled in this study. All patients carried the LOF allele and could calculate GRACE scores. The primary outcome was ischemic events (cardiac death, nonfatal myocardial infarction, and ischemic stroke) within 12 months. Secondary outcomes included the components of the primary outcome, all-cause mortality, Bleeding Academic Research Consortium (BARC) types 2, 3, and 5 bleeding events, and BARC types 3 and 5 bleeding events. The propensity score matching method was used to balance the baseline characteristics of patients. The Kaplan-Meier/log-rank test was adopted for the result analysis, and Cox regression was employed for adjusting for confounding factors. Results: = .026), while the risk of ischemic events or bleeding was comparable between the 2 treatment groups. Conclusion: LOF alleles suggest that GRACE risk stratification may help differentiate ischemic and bleeding risks post-PCI.