Why the study?
It was unknown whether personalized antiplatelet therapy guided by the CYP2C19 phenotype improves outcomes in patients receiving selective PCI.
Does CYP2C19 genotype-guided antiplatelet therapy reduce MACE in patients undergoing selective PCI?
Does CYP2C19 genotype-guided antiplatelet therapy reduce MACE in patients undergoing selective PCI?
In Chinese patients undergoing selective PCI, CYP2C19 genotype-guided antiplatelet therapy did not improve MACE outcomes compared to conventional clinical feature-guided therapy.
May support CYP2C19-guided antiplatelet therapy after elective PCI; leaves open need for randomized trials before practice change.
Aim: To observe if personalized antiplatelet therapy according to the CYP2C19 phenotype can improve the outcomes of patients receiving selective percutaneous coronary intervention (PCI). Methods: In this observational study, 677 Chinese patients undergoing selective PCI were divided into gene group (n = 369) and conventional group (n = 308), and given antiplatelet therapy according to the CYP2C19 genotype or clinical features, respectively. Incidence of MACE (death, non-fatal myocardial infarction, and unplanned repeat revascularization) and bleeding was compared between the two groups after 18 months. Results: Diabetes, heart dysfunction and SYNTAX score (>15), but not routinely CYP2C19 genotype test-guided antiplatelet therapy, were associated with MACE. The incidence of bleeding showed no difference. Conclusion: CYP2C19 phenotype-guided antiplatelet therapy may have no influence on the outcomes of selective PCI patients. Clinical features-guided antiplatelet therapy may be reasonable.
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Tan et al. (2019) studied this question.
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