Genotype-guided antiplatelet therapy compared with conventional therapy for patients with acute coronary syndromes: a systematic review and meta-analysis

To evaluate whether genotype-guided antiplatelet therapy reduces the rates of cardiovascular events and bleeding events in patients with acute coronary syndrome (ACS). We systematically searched Pubmed, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL) (searched in September 2018) for controlled studies evaluating genotype-guided antiplatelet therapy in ACS with percutaneous coronary intervention (PCI) or without PCI. The primary endpoint was a composite of death, myocardial infarction (MI), stroke, targeted vessel revascularization and/or major bleeding. A total of five studies involving 2900 patients were included. Compared with the conventional group, the genotype-guided group had a decreased risk of primary composite outcomes (RR= 0.54; 95% CI: 0.41–0.72; I2 = 30%), death (RR = 0.54; 95% CI: 0.32–0.94; I2 = 21%), MI (RR = 0.52; 95% CI: 0.31–0.88; I2 = 49%), targeted vessel revascularization (RR = 0.59; 95% CI: 0.35–0.98; I2 = 0%), but not for stroke (RR = 0.53; 95% CI: 0.22–1.24; I2 = 0%) and bleeding events (RR = 0.80; 95% CI: 0.51–1.25; I2 = 33%). Genotype-guided strategies could reduce the rates of cardiovascular events without increasing bleeding events compared with conventional treatment in ACS. Future multi-centre genotype-based randomized control trials are required to confirm these findings.