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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Results of genotype-guided antiplatelet therapy in patients who undergone percutaneous coronary intervention with
Jesús Sánchez-Ramos1, Cristina Lucía Dávila-Fajardo2, Pablo Toledo Frías1
1Department of Cardiology, Granada University Hospital, Institute for biomedical research, ibs.GRANADA, Spain.
Insights
A genotype-guided strategy for antiplatelet therapy reduced cardiovascular events after percutaneous coronary intervention. This approach did not increase bleeding risk, offering a safer treatment for patients with acute coronary syndrome.
Area of Science:
- Pharmacogenomics
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Clopidogrel is effective for acute coronary syndrome and percutaneous coronary intervention.
- Genetic variations (polymorphisms) influence clopidogrel response.
- CYP2C19 and ABCB1 gene variants impact clopidogrel efficacy and safety.
Purpose of the Study:
- To evaluate if a CYP2C19/ABCB1-genotype-guided antiplatelet strategy reduces cardiovascular events and bleeding.
- To compare a prospective genotype-guided approach with a retrospective non-tailored strategy.
Main Methods:
- Experimental study involving 719 patients undergoing percutaneous coronary intervention with stent.
- Intervention group: prospective genotype-guided strategy.
- Control group: retrospective non-tailored strategy.
- Primary endpoint: composite of cardiovascular death, acute coronary syndrome, or stroke at 12 months.
Main Results:
- The genotype-guided group had fewer primary endpoint events (10.1%) compared to the control group (14.1%) (HR 0.63, p=0.037).
- No significant difference in major or minor bleeding events between groups (4.1% vs. 4.7%, p=0.55).
- Within the intervention group, no difference in events or bleeding between clopidogrel and other antiplatelet therapies.
Conclusions:
- A genotype-guided strategy can decrease cardiovascular events post-percutaneous coronary intervention.
- This personalized approach appears safe, without increasing bleeding complications.
- Genotype-guided therapy offers a potentially improved treatment paradigm for patients undergoing PCI.
Background:
Clopidogrel has provided beneficial effects in acute coronary syndrome and percutaneous coronary intervention. Different polymorphisms have been associated with differences in clopidogrel response. The aim of this study was to check if CYP2C19/ABCB1-genotype-guided strategy reduces the rates of cardiovascular events and bleeding.
Methods:
This experimental study included patients undergoing percutaneous coronary intervention with stent. The prospective genotype-guided strategy (intervention group) was compared against a retrospective non-tailored strategy (control group). Primary efficacy endpoint was the composite of cardiovascular death, acute coronary syndrome or stroke during 12months after intervention. Secondary endpoint was to compare the efficacy of the different antiplatelet therapies used in genotyping conditions.
Results:
The study included 719 patients undergone stent, more than 86% with acute coronary syndrome. The primary endpoint occurred in 32 patients (10.1%) in the genotyping group and in 59 patients (14.1%) in the control group (HR 0.63, 95% CI (0.41-0.97), p =0.037). There was no difference in The Thrombolysis in Myocardial Infarction major and minor bleeding criteria between the two groups (4.1% vs. 4.7%, HR=0.80, 95% CI (0.39-1.63), p=0.55). In intervention group, there was no difference in the rate of events in patients treated with clopidogrel versus patients treated with other antiplatelet treatments (9.1% vs 11.5% p=0.44), or bleeding (3.7% vs 4.6%, p=0.69).
Conclusions:
The genotype-guided strategy could reduce the rates of composite of cardiovascular events and bleeding during 12months after percutaneous coronary intervention compared to a non-genotype-guide strategy.
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