Key result
Switching from ticagrelor to clopidogrel post-PCI shows no difference in MACE for ACS patients.
Why the study?
Optimizing antiplatelet therapy is crucial in ACS patients undergoing PCI, prompting evaluation of CYP2C19 loss-of-function variants and clinical outcomes with ticagrelor, clopidogrel, and aspirin.
Does switching from ticagrelor to clopidogrel affect major adverse cardiovascular events in ACS patients post-PCI with different CYP2C19 phenotypes?
Cohort (n=111)
No
Does switching from ticagrelor to clopidogrel affect major adverse cardiovascular events in ACS patients post-PCI with different CYP2C19 phenotypes?
Switching from ticagrelor to clopidogrel in ACS patients post-PCI showed no significant difference in MACE, though intermediate metabolizers exhibited a trend favoring ticagrelor continuation and increased target vessel reintervention upon aspirin withdrawal.
Answers are grounded in this paper and cite their sources.
May inform de-escalation decisions post-PCI; leaves open CYP2C19-guided strategies pending randomized confirmation.
OBJECTIVE: Optimizing antiplatelet therapy is crucial in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary interventions (PCIs). This study aimed to assess the prevalence of CYP2C19 loss-of-function (LOF) variants and evaluate the clinical outcome of ticagrelor, clopidogrel, and aspirin in patients with ACS-PCI. METHODS: This study included patients from the southern part of India (predominantly Tamil Nadu) with coronary artery disease and PCI. They were categorized based on their CYP2C19 LOF variants. Patients were further divided into group 1 (continued ticagrelor) and group 2 (switched to clopidogrel) and followed up for 40 months. The primary and secondary outcomes were evaluated. RESULTS: A total of 287 patients were genotyped, 36.2% were normal, 46.3% were intermediate, and 17.5% were poor metabolizers, the predominant allele being CYP2C19 *2. After considering only patients who underwent PCI and received ticagrelor, 111 patients were recruited. Ticagrelor was switched to clopidogrel in 45.9% of patients. No statistically significant differences in major adverse cardiovascular events or individual outcomes were observed among different metabolizer groups and patients switched from ticagrelor to clopidogrel. Intermediate metabolizers (IMs) exhibited a trend favoring ticagrelor continuation. Notably, discontinuation of aspirin in IM was linked to increased target vessel reintervention (TVR) in the clopidogrel-only group. CONCLUSION: Our study provides preliminary evidence on favoring ticagrelor continuation and increased TVR upon aspirin withdrawal in IM.
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Senguttuvan et al. (2025) conducted a cohort in Acute coronary syndrome (ACS) undergoing PCI (n=111). Switching to clopidogrel vs. Continuing ticagrelor was evaluated on Major adverse cardiovascular events. Switching from ticagrelor to clopidogrel in ACS patients post-PCI showed no significant difference in MACE over 40 months, though intermediate metabolizers showed a trend favoring ticagrelor.
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