Optimizing P2Y12 Inhibitor Therapy in Post-PCI Patients Through Genotype-Guided Strategies: A Systematic Review and...

Area of Science:

• Cardiovascular Medicine
• Pharmacogenomics
• Interventional Cardiology

Background:

• Clopidogrel non-response is a clinical challenge post-percutaneous coronary intervention (PCI).
• CYP2C19 genetic variations impact clopidogrel efficacy and bioavailability.
• Genotype testing can identify patients at risk for non-response.

Purpose of the Study:

• To evaluate the impact of genotype-guided versus conventional P2Y12 inhibitor therapy on post-PCI patient outcomes.
• To determine if genetic testing improves clinical efficacy and safety compared to standard care.

Main Methods:

• Systematic review and meta-analysis of 10 trials adhering to PRISMA and AMSTAR-2 guidelines.
• Inclusion of adult patients undergoing PCI, comparing genotype-guided and conventional P2Y12 inhibitor therapy.
• Assessment of outcomes including mortality, MACE, myocardial infarction, stroke, stent thrombosis, and bleeding events up to October 2022.

Main Results:

• Pooled analysis of 10 studies (4300 patients) showed genotype-guided therapy significantly reduced all-cause mortality (RR: 0.59) and MACE (RR: 0.66).
• Significant reductions were observed in myocardial infarction (RR: 0.59) and stent thrombosis (RR: 0.55).
• No significant increase in bleeding events (RR: 0.83) was noted, with a decrease in stroke (RR: 0.56).

Conclusions:

• Genotype-guided P2Y12 inhibitor therapy significantly enhances clinical outcomes for post-PCI patients.
• This approach reduces mortality, MACE, myocardial infarction, and stent thrombosis without elevating bleeding risk.
• Integration of genetic testing into clinical practice is recommended for optimizing dual antiplatelet therapy (DAPT).