Genotype Testing Effectively Guides Post-PCI P2Y12 Inhibitor Therapy

The following article is a part of conference coverage from the American Heart Association Scientific Sessions 2021, being held virtually from November 13 to 15, 2021. The team at Cardiology Advisor will be reporting on the latest news and research conducted by leading experts in cardiology. Check back for more from the AHA Scientific Sessions 2021.

Genotype testing is an effective strategy to guide P2Y12 inhibitor antiplatelet therapy following percutaneous coronary intervention, according to study results presented at AHA 2021, held from November 13 to 15, 2021.

Investigators performed a literature review using PubMed, Embase, and Cochrane databases to identify 7 studies on genotype-guided P2Y12 inhibitor therapy in patients with acute coronary syndrome who underwent percutaneous coronary intervention. Study endpoints were incidences of major adverse cardiovascular events, cardiovascular mortality, myocardial infarction, and stroke. DerSimonian and Laird random-effects modeling were used to calculate summary effects.

A total of 9617 patients were included in the meta-analysis. Genotype testing was used to guide a prasugrel or ticagrelor prescription in patients with loss of function of CYP219 alleles and clopidogrel prescription in patients without loss of function alleles. Patients without genotype testing were treated with clopidogrel.

Compared with the conventional arm, the genotype-guided therapy arm reported a reduction in major adverse cardiovascular events (risk ratio [RR] 0.72; 95% CI, 0.55-0.95; P =.02), improved cardiovascular mortality (RR 0.62; 95% CI, 0.43-0.90; P =.01), and decreased incidence of myocardial infarction (RR 0.57; 95% CI, 0.41-0.97; P <.01).

Both treatment arms reported similar incidence of stroke (RR 0.65; 95% CI, 0.35-1.21; P =.18). The genotype-guided therapy arm also had fewer treatment-related adverse events, reporting a decrease in stent thrombosis (RR 0.52; 95% CI, 0.28-0.96; P =.04).

Patients with acute coronary syndrome who underwent percutaneous coronary intervention benefited from a genotype-guided P2Y12 inhibitor antiplatelet strategy. Investigators indicated that genotype-guided treatments were associated with reductions in major adverse cardiovascular events, cardiovascular mortality, myocardial infarction, and stent thrombosis.

Reference

Gupta R, Malik A, Chaturvedi A, et al. Effect of genotype guided oral P2Y12 inhibitor selection after percutaneous coronary intervention: a systematic review and meta-analysis of randomized clinical trials. Presented at: AHA 2021; November 13-15, 2021. Poster P4.