Impact of the ABCD-GENE Score on Clopidogrel Clinical Effectiveness after PCI: A Multi-Site, Real-World Investigation

Area of Science:

• Cardiology
• Pharmacogenomics
• Clinical Risk Stratification

Background:

• Clopidogrel is a P2Y12 inhibitor used to prevent atherothrombotic events after percutaneous coronary intervention (PCI).
• Diminished clopidogrel antiplatelet effects can be influenced by genetic variants (CYP2C19) and clinical factors.
• The ABCD-GENE score was developed to predict these diminished effects.

Purpose of the Study:

• To validate the ABCD-GENE score's ability to predict atherothrombotic events in a diverse, real-world population of clopidogrel-treated patients post-PCI.
• To assess the association between ABCD-GENE score and major atherothrombotic events and major adverse cardiovascular events (MACE).

Main Methods:

• A total of 2,341 adult patients who underwent PCI, received clopidogrel, and had CYP2C19 genotyping were included.
• The primary outcome was a composite of major atherothrombotic events within 12 months post-PCI.
• The secondary outcome was MACE, and outcomes were compared between patients with ABCD-GENE scores ≥10 and <10.

Main Results:

• Patients with an ABCD-GENE score ≥10 had a significantly higher risk of major atherothrombotic events (24.6 vs. 14.7 events per 100 patient-years; adjusted HR 1.66).
• The risk for MACE was also significantly higher in patients with an ABCD-GENE score ≥10 (16.7 vs. 10.1 events per 100 patient-years; adjusted HR 1.59).
• These findings were consistent across a diverse, real-world patient population.

Conclusions:

• The ABCD-GENE score effectively predicts a higher risk of atherothrombotic events and MACE in clopidogrel-treated patients post-PCI.
• A score of ≥10 suggests diminished clopidogrel effectiveness, supporting its use in guiding antiplatelet therapy decisions.
• Clinical implementation of the ABCD-GENE score can aid in personalized antiplatelet strategies for patients undergoing PCI.