Implementing a pharmacogenomic-driven algorithm to guide antiplatelet therapy among Caribbean Hispanics: a...

Area of Science:

• Cardiovascular Medicine
• Pharmacogenomics
• Clinical Decision Support Systems

Background:

• Oral antiplatelet therapy is crucial after percutaneous coronary intervention (PCI).
• Genetic variations can affect drug metabolism and efficacy, leading to suboptimal outcomes.
• Personalized medicine approaches, like pharmacogenetics, aim to optimize antiplatelet therapy selection.

Purpose of the Study:

• To evaluate if genotype-guided antiplatelet selection using a clinical decision support (CDS) algorithm reduces major adverse cardiovascular and cerebrovascular events (MACCEs) in Caribbean Hispanic patients post-PCI.
• To assess the efficacy of a pharmacogenetic (PGx)-CDS algorithm in guiding antiplatelet therapy selection.

Main Methods:

• An open-label, multicentre, non-randomised clinical trial involving 300 Caribbean Hispanic patients undergoing PCI.
• Patients were assigned to standard-of-care (SoC) or genotype-guided (PGx-CDS) groups.
• The PGx-CDS group received treatment recommendations based on a risk prediction algorithm incorporating genetic data, with ticagrelor recommended for high-risk patients (score ≥2).

Main Results:

• The genotype-guided group showed a clinically lower, though not statistically significant, risk of MACCEs compared to the SoC group (8.7% vs 10.7%).
• Among high-risk patients, genotype-guided therapy significantly reduced MACCE incidence by 6 months post-PCI (adjusted HR=0.104; p<0.0001).

Conclusions:

• Implementing the PGx-CDS algorithm demonstrated a significant benefit in reducing MACCEs exclusively in high-risk Caribbean Hispanic patients after PCI.
• The findings suggest that genotype-guided therapy can optimize antiplatelet selection and improve outcomes in specific patient subgroups.