Key result
A genotype-guided antiplatelet treatment strategy after percutaneous coronary intervention resulted in a major adverse cardiovascular event rate of 1.5% at 6 months.
Why the study?
The study was conducted to estimate the incidence of major adverse cardiovascular events with genotype test-guided antiplatelet therapy in patients undergoing PCI for acute coronary syndrome.
Does genotype test-guided antiplatelet therapy reduce major adverse cardiovascular events in patients undergoing percutaneous coronary intervention?
Observational (n=151)
No
Does genotype test-guided antiplatelet therapy reduce major adverse cardiovascular events in patients undergoing percutaneous coronary intervention?
A genotype-guided antiplatelet strategy after PCI, tailoring P2Y12 inhibitor choice and dose to CYP2C19 metabolizer status, was associated with a low 1.5% incidence of MACE at 6 months.
Answers are grounded in this paper and cite their sources.
Genotype-guided antiplatelet de-escalation yielded low MACE rates post-PCI; hypothesis-generating and should not yet change practice.
OBJECTIVE: To estimate the incidence of major adverse cardiovascular events (MACE) with genotype test-guided antiplatelet therapy in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome. METHODS: Patients who had undergone PCI for acute coronary syndrome as well as stable coronary artery disease were recruited. Salivary samples were obtained from these patients and genotyped for CYP2C19∗2, CYP2C19∗3 variations by sequencing method (GAAP x method). Patients were categorized as normal (GG, GG) (29%), intermediate (AG) (52%) or poor metabolizes (homozygous variant AA) (19%). Dual antiplatelets were given based on the genotyping data. Poor metabolizes received newer agent (ticagrelor), intermediate metabolizes received double-dose of clopidogrel and normal metabolizes received therapeutic doses of clopidogrel. All subjects were followed-up for six months. RESULTS: Based on the genotyping data of CYP2C19∗2 and CYP2C19∗3 variations, it was found that most patients were categorized as 'intermediate' (78, 51.65%), followed by 'normal' (43, 28.48%) and 'poor' metabolizes (30, 19.87%). Only 3 (1.5%) of 151 patients reported MACE at follow-up. CONCLUSIONS: Genotyping for CYP2C19 variations to assess clopidogrel resistance in patients undergoing PCI and subsequent drug selection helps reduce MACE after coronary intervention.
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Ramesh et al. (2020) conducted an observational in Acute and chronic coronary syndrome undergoing percutaneous coronary intervention (n=151). Genotype test-guided antiplatelet therapy was evaluated on Major adverse cardiovascular events (MACE). A genotype-guided antiplatelet treatment strategy after percutaneous coronary intervention resulted in a major adverse cardiovascular event rate of 1.5% at 6 months.
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