What question did this study set out to answer?

To evaluate the utility of the ABCD-GENE score for guiding P2Y12 inhibitor selection and predicting ischemic outcomes following percutaneous coronary intervention.

February 8, 2022Journal of the American Heart AssociationOpen Access

ABCD‐GENE Score and Clinical Outcomes Following Percutaneous Coronary Intervention: Insights from the TAILOR‐PCI Trial

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Why the study?

In TAILOR-PCI, genotype-guided P2Y12 inhibitor selection after PCI did not significantly reduce ischemic events at 12 months, prompting investigation of the ABCD-GENE score for tailoring therapy.

Does genotype-guided P2Y12 inhibitor selection reduce ischemic events compared to conventional selection in patients following percutaneous coronary intervention when stratified by the ABCD-GENE score?

Key Points

To evaluate the utility of the ABCD-GENE score for guiding P2Y12 inhibitor selection and predicting ischemic outcomes following percutaneous coronary intervention.
Conducted a post hoc analysis of the randomized TAILOR-PCI trial (NCT01742117) comparing genotype-guided versus conventional P2Y12 inhibitor selection.
Stratified patients into high (≥10 points) and low (<10 points) ABCD-GENE score categories across 3,883 patients discharged on clopidogrel and a total cohort of 4,714 patients followed for 12 months.
Among patients discharged on clopidogrel, a high ABCD-GENE score was significantly associated with higher 12-month rates of the primary outcome (5.2% vs. 2.6%, P < 0.001) and secondary outcome (7.7% vs. 4.6%, P = 0.001) compared to a low score.
Genotype-guided selection did not significantly reduce 12-month primary (p-interaction = 0.48) or secondary (p-interaction = 0.27) ischemic outcomes compared to conventional therapy across either ABCD-GENE score group.

Structured PICO

Population

4,714 patients following percutaneous coronary intervention from the TAILOR-PCI trial, including a subgroup of 3,883 patients discharged on clopidogrel

Intervention

Genotype-guided P2Y12 inhibitor selection

Comparator

Conventional P2Y12 inhibitor selection

Outcome

Composite of death, myocardial infarction, or stroke at 12 monthscomposite

While the ABCD-GENE score successfully identifies PCI patients on clopidogrel at higher risk for ischemic events, genotype-guided P2Y12 inhibitor selection does not significantly improve outcomes regardless of the score.

Limitations

post hoc analysis

Implication

High ABCD-GENE score flags higher ischemic risk on clopidogrel post-PCI; leaves open whether score-guided P2Y12 selection improves outcomes.

Abstract

Background In TAILOR‐PCI, genotype‐guided selection of P2Y 12 inhibitors after percutaneous coronary intervention did not significantly reduce the risk of ischemic events at 12 months. The Age, Body Mass Index, Chronic Kidney Disease, Diabetes, and Genotyping (ABCD‐GENE) score identifies patients with high platelet reactivity on clopidogrel at increased risk of ischemic events. The aim of this study was to investigate the value of the ABCD‐GENE score for tailoring P2Y 12 inhibitor selection after percutaneous coronary intervention. Methods and Results In a post hoc analysis of the TAILOR‐PCI, outcomes were analyzed by ABCD‐GENE score and allocation to genotype‐guided or conventional P2Y 12 inhibitor selection. Primary (death, myocardial infarction, or stroke) and secondary (cardiovascular death, myocardial infarction, stroke, stent thrombosis, or severe recurrent ischemia) outcomes were assessed. Among 3883 patients discharged on clopidogrel in the genotype‐guided and conventional therapy groups, 15.8% and 84.2% had high (≥10 points) or low (<10) ABCD‐GENE scores, respectively. At 12 months, both the primary (5.2% versus 2.6%, P <0.001) and secondary outcomes (7.7% versus 4.6%, P =0.001) were significantly increased in patients with high ABCD‐GENE score. Among 4714 patients allocated to genotype‐guided or conventional therapy, the former did not significantly reduce the 12‐month risk of the primary and secondary outcomes in both the high and low ABCD‐GENE score groups (p interaction =0.48 and 0.27, respectively). Conclusions Among patients with percutaneous coronary intervention on clopidogrel, the ABCD‐GENE score was helpful in identifying those at higher risk. The ABCD‐GENE score may potentially enhance the precision of tailored selection of P2Y 12 inhibitors, which needs to be confirmed in prospective investigations. Clinical Trial Registration URL: http://www.clinicaltrials.gov . Unique Identifier: NCT01742117.