Meta-Analysis of the Efficacy and Safety of Genotype-Guided Strategy for Selection of P2Y 12 Inhibitors in Coronary Artery Disease

• Published in: The American journal of cardiology Vol. 136; p. 168
• Main Authors: Nazir, Salik, Ahuja, Keerat Rai, Elzanaty, Ahmed, Patel, Neha J, Mahmood, Muhammad, Changal, Khalid, Macciocca, Michael, Gupta, Rajesh
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01.12.2020
• Subjects: Acute coronary syndromes; Angioplasty; Antiplatelet therapy; Bleeding; Cardiovascular disease; Clinical trials; Complications; Coronary artery; Coronary artery disease; Coronary Artery Disease - drug therapy; Coronary vessels; Genotype; Genotype & phenotype; Genotypes; Health services; Heart diseases; Humans; Meta-analysis; Mortality; Purinergic P2Y Receptor Antagonists - adverse effects; Purinergic P2Y Receptor Antagonists - therapeutic use; Stents; Strategy; Stroke; Subgroups; Thrombosis; Treatment Outcome; United States > US
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2020.09.023

Given their increased potency, they carry a higher risk of bleeding complications.4 In a previous meta-analysis, we reported reduced rates of major adverse cardiovascular events (MACE) in acute coronary syndrome (ACS) patients who underwent treatment with genotype-guided strategy (GGS) utilizing CYP2C19 testing versus conventional strategy (CS).5 The recently published Tailored Antiplatelet Initiation to Lessen Outcomes Due to Decreased Response after Percutaneous Coronary Intervention (TAILOR-PCI) trial did not show any benefit of CYP2C19-guided treatment.6 The trial was possibly underpowered since the study had lower than expected event rates, and was powered to detect a large effect size of a 50% reduction in the primary endpoint with GGS. [...]we sought to analyze further evidence using pooled data form multiple published randomized controlled trials (RCTs). Patients with ACS are at higher risk of thrombotic events. [...]in our study, we did a subgroup analysis of patients with ACS after excluding the Assessment of Prospective CYP2C19 Genotype Guided Dosing of Anti-Platelet Therapy in Percutaneous Coronary Intervention (ADAPT) trial.9 This trial included heterogeneous population (50% stable coronary artery disease and 50% ACS). [...]36% of randomized subjects in the CS group of TAILOR-PCI trial had CYP2C19 loss of function variants.