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Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
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ABCD-GENE Score and Clinical Outcomes Following Percutaneous Coronary Intervention: Insights from the TAILOR-PCI

Davide Capodanno1, Dominick J Angiolillo2, Ryan J Lennon3

  • 1Division of Cardiology Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco"University of Catania Catania Italy.

Journal of the American Heart Association
|February 8, 2022
PubMed

Insights

The Age, Body Mass Index, Chronic Kidney Disease, Diabetes, and Genotyping (ABCD-GENE) score effectively identifies patients at high risk for ischemic events after percutaneous coronary intervention. However, genotype-guided P2Y12 inhibitor selection did not improve outcomes in TAILOR-PCI study patients.

Area of Science:

  • Cardiology
  • Pharmacogenomics
  • Interventional Cardiology

Background:

  • TAILOR-PCI trial showed genotype-guided P2Y12 inhibitor selection did not reduce ischemic events post-percutaneous coronary intervention (PCI).
  • The Age, Body Mass Index, Chronic Kidney Disease, Diabetes, and Genotyping (ABCD-GENE) score identifies patients with high platelet reactivity on clopidogrel, indicating increased ischemic risk.
  • This study evaluated the ABCD-GENE score's utility in tailoring P2Y12 inhibitor selection after PCI.

Purpose of the Study:

  • To assess the value of the ABCD-GENE score in identifying high-risk patients undergoing PCI.
  • To investigate if the ABCD-GENE score can guide P2Y12 inhibitor selection for improved outcomes.
  • To analyze outcomes based on ABCD-GENE score and treatment allocation (genotype-guided vs. conventional).

Main Methods:

  • Post hoc analysis of the TAILOR-PCI trial data.
  • Patients were stratified by ABCD-GENE score (high ≥10 vs. low <10) and treatment allocation.
  • Primary outcomes (death, MI, stroke) and secondary outcomes (CV death, MI, stroke, stent thrombosis, severe recurrent ischemia) were assessed at 12 months.

Main Results:

  • Among 3883 patients on clopidogrel, 15.8% had a high ABCD-GENE score.
  • Patients with a high ABCD-GENE score had significantly increased primary (5.2% vs. 2.6%) and secondary (7.7% vs. 4.6%) outcomes at 12 months.
  • Genotype-guided therapy did not significantly reduce outcomes compared to conventional therapy in either high or low ABCD-GENE score groups (p-interaction=0.48 and 0.27, respectively).

Conclusions:

  • The ABCD-GENE score is a valuable tool for identifying patients at higher risk of ischemic events after PCI.
  • While the ABCD-GENE score aids risk stratification, genotype-guided P2Y12 inhibitor selection did not demonstrate a significant benefit in this analysis.
  • Prospective studies are needed to confirm the ABCD-GENE score's role in optimizing P2Y12 inhibitor selection post-PCI.

Keywords:
antiplatelet therapygenetic testingischemiapercutaneous coronary intervention

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