Key result
Genotype-guided antiplatelet therapy significantly reduced the risk of major adverse cardiovascular events (RR 0.60) compared to standard treatment in patients with coronary artery disease or undergoing PCI.
Why the study?
Previous studies on the efficacy and safety of genotype-guided antiplatelet therapy in patients with CAD or undergoing PCI have been inconclusive.
Does genotype-guided antiplatelet treatment reduce major adverse cardiovascular events in patients with CAD or undergoing PCI?
Meta-Analysis (n=11,740)
Does genotype-guided antiplatelet treatment reduce major adverse cardiovascular events in patients with CAD or undergoing PCI?
Relative Risk: 0.6 (95% CI 0.44–0.82)
p-value: p=0.001
Genotype-guided antiplatelet therapy reduces ischemic events without increasing bleeding compared to standard therapy in patients with CAD or undergoing PCI, with particular benefit in ACS and Chinese populations.
Supports genotype-guided antiplatelet therapy in CAD/PCI; confirms benefit where prior evidence was inconclusive.
OBJECTIVE: Previous studies on the efficacy and safety of genotype-guided antiplatelet therapy in patients with coronary artery disease (CAD) or undergoing percutaneous coronary intervention (PCI) have been inconclusive. AIM: We conducted a meta-analysis to evaluate if the genotype-guided antiplatelet strategy is superior to the standard therapy in patients with CAD or undergoing PCI. METHOD: PubMed, Web of Science, Embase, and Cochrane Central Register of Controlled Trials databases were searched up to October 1st, 2021. Studies reporting efficacy and safety outcomes in the genotype-guided treatment and standard treatment groups were included. The two groups were statistically compared. RESULT: Eleven randomized controlled trials (RCTs) involving 11740 patients were included in this meta-analysis. Compared with the standard treatment group, the genotype-guided group had significant lower risks of all efficacy outcomes, including major adverse cardiovascular events (MACEs) (RR 0.60, 95%, CI 0.44-0.82, P=0.001), all-cause death (RR 0.70, 95% CI 0.51-0.95, P=0.02), cardiovascular death (RR 0.71, 95% CI 0.53-0.95, P=0.02), myocardial infarction (RR 0.53, 95% CI 0.42-0.67, P<0.0001), stroke (RR 0.64, 95% CI 0.41-0.98, P=0.04), stent thrombosis (RR 0.63, 95% CI 0.43-0.91, P=0.01) and targeted vessel revascularization (RR 0.79, 95% CI 0.67-0.92, P=0.003). There was no significant difference in any bleeding events between the two groups. As a result of the subgroup analyses, the genotype-guided treatment was more likely to reduce the incidence of MACEs in the subgroup where the proportion of patients with ACS was ≥ 90%, and subgroup of the Chinese population. CONCLUSION: Genotype-guided antiplatelet treatment could reduce the risk of MACEs without increasing the risk of bleeding events as compared with the standard treatment in patients with CAD or those undergoing PCI. In addition, Genotype-guided antiplatelet treatment might benefit Chinese population or patients with ACS.
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Tang et al. (2022) conducted a meta-analysis in Coronary Artery Disease (CAD) or undergoing percutaneous coronary intervention (PCI) (n=11,740). Genotype-guided antiplatelet therapy vs. Standard therapy was evaluated on Major adverse cardiovascular events (MACEs) (RR 0.60, 95% CI 0.44-0.82, p=0.001). Genotype-guided antiplatelet therapy significantly reduced the risk of major adverse cardiovascular events (RR 0.60) compared to standard treatment in patients with coronary artery disease or undergoing PCI.
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