Key result
In South-East Asian ACS patients on clopidogrel, CYP2C19 loss-of-function carriers experienced significantly higher rates of MACE compared with non-carriers (8.0% vs 5.4%, P=0.041).
Why the study?
The study aimed primarily to evaluate the impact of using platelet reactivity testing to escalate antiplatelet therapy and secondarily to assess the association of CPIC phenotype with MACE outcomes in South-East Asian ACS patients.
Does CYP2C19 phenotype and escalation of antiplatelet therapy impact MACE and bleeding in South-East Asian ACS patients undergoing PCI?
Observational (n=238)
Does CYP2C19 phenotype and escalation of antiplatelet therapy impact MACE and bleeding in South-East Asian ACS patients undergoing PCI?
Absolute Event Rate: 8% vs 5.4%
p-value: p=.041
In South-East Asian ACS patients, CYP2C19 loss-of-function phenotype is an independent predictor of MACE when treated with clopidogrel, and switching to prasugrel increases bleeding risk.
Cautious interpretation warranted; supports association in South-East Asians but leaves open whether genotyping improves outcomes.
WHAT IS KNOWN AND OBJECTIVE: ) phenotype grouping to study the associations. We primarily aimed to study the impact of use of platelet reactivity testing to escalate antiplatelet therapy and secondarily to study the association of CPIC phenotype with MACE outcomes in South-East Asian Acute Coronary Syndrome (ACS) subjects. METHOD: A retrospective genotype study was performed on 238 percutaneous coronary intervention subjects, originally planned for escalation of antiplatelets using platelet reactivity testing. RESULTS AND DISCUSSION: There was no difference in MACE between the switched and unswitched groups; however, 'all bleeds' and 'clinically significant bleeds' (CSB) were statistically higher in the patients who were switched to prasugrel. The subgroup of patients who remained on clopidogrel (n = 199) were analysed using phenotype categories and MACE. Eleven percent (11.4%) of CYP2C19 poor metabolizers (PM) suffered MACE, compared with 1.3% of extensive metabolizers (EM). LoF-Clopidogrel patients are significantly more likely to experience MACE compared with non-LoF subjects (8.0% vs 5.4%, P: .041). WHAT IS NEW AND CONCLUSION: In our multivariate analysis, LoF-Clopidogrel, malay ethnicity, diabetics and use of proton pump inhibitors were independent predictors of MACE. There were numerically more bleeds in LoF subjects who were on prasugrel compared with Clopidogrel (23.5% vs 11%, P = .082). Our data corroborate with current findings on platelet reactivity testing, suggesting that the assay would not be sensitive enough to pick up sufficient 'at-risk' subjects as compared to the use of CYP2C19 genotyping.
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Tan et al. (2019) conducted an observational in Acute Coronary Syndrome (n=238). CYP2C19 Loss-of-Function (LoF) phenotype vs. Non-LoF phenotype was evaluated on Major adverse cardiovascular events (MACE) (p=.041). In South-East Asian ACS patients on clopidogrel, CYP2C19 loss-of-function carriers experienced significantly higher rates of MACE compared with non-carriers (8.0% vs 5.4%, P=0.041).
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