ABCD-GENE Score and Bleeding in Post-PCI Patients: Implications for Guided De-Escalation of Antiplatelet Therapy

BackgroundThe ABCD-GENE (Age, Body Mass Index, Chronic Kidney Disease, Diabetes Mellitus, and Genotyping) score is a tool used to identify increased thrombotic risk in clopidogrel-treated patients. We evaluated the association between a low ABCD-GENE score (<10) and Bleeding Academic Research Consortium (BARC)-defined bleeding among prasugrel or ticagrelor and clopidogrel-treated patients.MethodsThis was an IRB-approved retrospective cohort study of patients who underwent percutaneous coronary intervention (PCI) and CYP2C19 genotyping. The primary outcome was time to first bleed of any severity within 1 year. Time to first major bleed, defined by BARC 3a, 3b, 3c, or 5 criteria, and major adverse cardiovascular events (MACE) were secondary outcomes. BARC bleeding events were compared between prasugrel or ticagrelor and clopidogrel-treated patients and stratified by the ABCD-GENE score threshold of ≥10. Kaplan-Meier and multivariable Cox proportional hazards model were used for time-to-event analyses.ResultsOf 2547 patients, 1760 were in the low score group, and 787 were in the high score group. Kaplan-Meier analysis showed that any bleeding (P = .008) and major bleeding (P = .015) were less for those with a low score compared to a high score. Among those in the low score group, any bleeding (P < .001) and major bleeding (P = .022) were lower with clopidogrel versus prasugrel or ticagrelor. However, the ABCD-GENE score was not independently associated with bleeding in the Cox model. No difference in MACE was observed by treatment in the low score group.ConclusionsThe ABCD-GENE score was associated with BARC bleeding, yet other variables had a greater impact such as history of GI bleed, anticoagulation, P2Y12 inhibitor, and age. Patients with a low score who received prasugrel or ticagrelor had more bleeding versus clopidogrel. Our findings support further evaluation of the ABCD-GENE score as a tool for guided P2Y12 inhibitor de-escalation post-PCI.