Key result
Neither genotype- nor phenotype-guided antiplatelet therapy was superior to standard of care for MACE (genotype OR 0.64, 95% CI 0.38-1.05; phenotype OR 0.93, 95% CI 0.54-1.37) in PCI-treated CAD.
Why the study?
Although recommended for PCI-treated acute coronary syndrome, receptor inhibitors carry high bleeding risk, making personalized antiplatelet therapy potentially valuable for guiding treatment selection.
Does genotype- or phenotype-guided antiplatelet therapy reduce MACE or bleeding in patients with coronary artery disease undergoing PCI?
Meta-Analysis (n=6,845)
Does genotype- or phenotype-guided antiplatelet therapy reduce MACE or bleeding in patients with coronary artery disease undergoing PCI?
Odds Ratio: 0.64 (95% CI 0.38–1.05)
Genotype- and phenotype-guided antiplatelet therapy did not show superiority over conventional therapy in reducing MACE or bleeding in patients undergoing PCI.
Guided antiplatelet strategies show no MACE reduction versus standard care; confirms conventional therapy remains appropriate for PCI patients.
OBJECTIVES: This study aimed to evaluate the efficacy and safety of genotype- and phenotype-guided intensified antiplatelet therapy compared with conventional therapy in patients undergoing stent implantation. BACKGROUND: receptor inhibitors are recommended for percutaneous coronary intervention (PCI)-treated acute coronary syndrome, their usage is limited by a high bleeding risk. Therefore, personalized antiplatelet therapy could provide a valuable foundation for selection of antiplatelet therapy in this population. METHODS: We conducted a Bayesian network meta-analysis for all randomized clinical trials (RCTs) that evaluated genotype- and/or phenotype-guided therapy in PCI-treated coronary artery disease. RESULTS: Thirteen RCTs were included with a total of 6,845 patients. The results showed no significant differences in major adverse cardiovascular events (MACE) between the treatment options ((genotype guided vs. standard of care; OR 0.64; 95% CI: 0.38-1.05) and (phenotype vs. standard of care; OR 0.93; 95% CI: 0.54-1.37)). In addition, no significant differences were demonstrated in bleeding events ((genotype guided vs. standard of care; OR 0.73; 95% CI: 0.45-1.25) and (phenotype vs. standard of care; OR 0.90; 95% CI: 0.62-1.39)). CONCLUSIONS: In this mixed treatment meta-analysis of RCTs, neither genotype- nor phenotype-guided antiplatelet therapy in patients with PCI-treated coronary artery disease was superior to conventional therapy.
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Kheiri et al. (2019) conducted a meta-analysis in Coronary artery disease undergoing percutaneous coronary intervention (n=6,845). Genotype- and phenotype-guided antiplatelet therapy vs. Conventional therapy (standard of care) was evaluated on Major adverse cardiovascular events (MACE) (OR 0.64, 95% CI 0.38-1.05). Neither genotype- nor phenotype-guided antiplatelet therapy was superior to standard of care for MACE (genotype OR 0.64, 95% CI 0.38-1.05; phenotype OR 0.93, 95% CI 0.54-1.37) in PCI-treated CAD.
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