Key result
Pharmacogenomic-guided P2Y12 therapy shows no significant benefit over usual care for major limb or CV events.
Why the study?
Does pharmacogenomic-guided P2Y12 inhibitor therapy reduce major adverse limb and cardiovascular events compared to usual care without testing in adult veterans with peripheral arterial disease undergoing revascularization?
Cohort (n=146)
Does pharmacogenomic-guided P2Y12 inhibitor therapy reduce major adverse limb and cardiovascular events compared to usual care without testing in adult veterans with peripheral arterial disease undergoing revascularization?
Answers are grounded in this paper and cite their sources.
In this pilot study of veterans undergoing peripheral arterial revascularization, pharmacogenomic-guided P2Y12 inhibitor therapy did not significantly reduce overall major adverse limb and cardiovascular events compared to usual care, though it was associated with lower ischemic events between 7 and 12 months despite initial testing delays.
After revascularization, patients with peripheral arterial disease (PAD) are at risk for ischemia. CYP2C19 variants may impact outcomes in those receiving clopidogrel but data is limited in PAD. This pilot study evaluated pharmacogenomic (PGx) guided care in 146 adult patients who underwent revascularization and were prescribed P2Y12 inhibitors. PGx testing was compared to no testing, with 61 patients in the PGx group vs 85 in control (clopidogrel only group). Clopidogrel was used in 97% of patients at baseline. Use of aspirin (64.7% vs 85.2%; p < 0.01) as well as stent interventions (44.7% vs 80%; p < 0.01) were less frequent in the control group, but P2Y12 inhibitor therapy duration was longer (10.2 ± 3.4 vs 8.0 ± 4.0 months; p < 0.04). Roughly one-third of patients were switched from clopidogrel based on PGx. Overall, in the control group, the composite of major adverse limb and cardiovascular events (45.9% vs 32.8%; p = 0.11), as well as bleeding events (14.1% vs 9.8%; p = 0.43) were non-significantly higher. At 7–12 months after revascularization, ischemic events were significantly lower in the PGx group (21.3% vs 4.7%; p = 0.01). A majority of ischemic events in the PGx group occurred within 90 days, and timely PGx testing was found to be delayed.
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Bridge et al. (2026) conducted a cohort in Peripheral arterial disease undergoing revascularization (n=146). Pharmacogenomic (PGx) guided P2Y12 inhibitor therapy vs. Usual care without PGx testing (clopidogrel only) was evaluated on Composite of major adverse limb and cardiovascular events (p=0.11). Pharmacogenomic-guided P2Y12 therapy had non-significantly lower major adverse limb and CV events vs usual care (32.8% vs 45.9%; p=0.11), and lower 7–12 month ischemic events (4.7% vs 21.3%; p=0.01).
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