Genotype-guided antiplatelet therapy compared with conventional therapy for patients with acute coronary syndromes: a
Lukai Zheng1, Chunsong Yang2, Lingbao Xiang3
1a Center of Cerebrovascular Diseases, Department of Neurology, West China Hospital, Sichuan University , Chengdu , China.
Insights
Genotype-guided antiplatelet therapy significantly reduced cardiovascular events, including death and myocardial infarction, in acute coronary syndrome (ACS) patients. This personalized approach did not increase bleeding risks compared to standard treatment.
Area of Science:
- Cardiology
- Pharmacogenomics
- Clinical Trials
Background:
- Acute coronary syndrome (ACS) management often involves antiplatelet therapy.
- Individual responses to antiplatelet drugs can vary, impacting treatment efficacy and safety.
- Genetic variations influence drug metabolism and efficacy, suggesting a potential for personalized therapy.
Purpose of the Study:
- To determine if genotype-guided antiplatelet therapy improves outcomes in ACS patients.
- To assess the impact of genotype-guided therapy on cardiovascular events and bleeding complications.
- To compare genotype-guided strategies against conventional antiplatelet treatment in ACS.
Main Methods:
- Systematic literature search of PubMed, Embase, and CENTRAL databases (up to September 2018).
- Inclusion of controlled studies evaluating genotype-guided antiplatelet therapy in ACS patients, with or without percutaneous coronary intervention (PCI).
- Primary endpoint analysis focused on a composite of death, myocardial infarction (MI), stroke, target vessel revascularization, and/or major bleeding.
Main Results:
- Five studies with 2900 patients were analyzed.
- Genotype-guided therapy showed a reduced risk of the primary composite outcome (RR=0.54), death (RR=0.54), MI (RR=0.52), and target vessel revascularization (RR=0.59).
- No significant reduction was observed for stroke or bleeding events.
Conclusions:
- Genotype-guided antiplatelet therapy can decrease cardiovascular event rates in ACS patients.
- This personalized approach appears safe, as it does not elevate bleeding event risks.
- Further multi-center, genotype-based randomized controlled trials are warranted to validate these findings.
Abstract:
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.
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