Genotype-guided personalization of antiplatelet treatment: A meta-analysis of patients with ACS or undergoing PCI.

Affiliation

Department of Cardiology & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China. Electronic address: [Email]

Abstract

BACKGROUND : Personalized antiplatelet treatment in patients with acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI) remains challenging in clinical practice. The present study aimed to explore the benefit of genotype-guided antiplatelet treatment with P2Y12 inhibitors in patients with ACS or undergoing PCI.
METHODS : A literature search was conducted (from inception to September 2018) in the PUBMED, EMBASE and Cochrane databases. Studies were included in which the genotype-guided P2Y12 inhibitor antiplatelet strategy was compared with the standard strategy in patients with ACS or undergoing PCI. The endpoints were high on-treatment platelet reactivity (HTPR), major adverse cardiovascular events including all-cause mortality, myocardial infarction (MI), stent thrombosis (ST), stroke and target-vessel revascularization (TVR), and major bleedings.
RESULTS : A total of 3377 patients in 9 studies (5 RCTs and 4 non-RCTs) were included, in which 91% of the patients were diagnosed with ACS and 88.5% underwent PCI. A total of 1639 patients (48.5%) were assigned to the genotype-guided group, and 1738 (51.4%) assigned to the conventional or standard (STD) group, with an average follow-up time of 7.6 months. After the pooled analysis, significantly lower risks of HTPR (HR: 0.32, 95% CI: 0.18-0.55, P < 10-4), all-cause mortality (HR: 0.55, 95% CI: 0.37-0.83, p = 0.005), MI (HR: 0.43, 95% CI: 0.27-0.67, p = 0.0002) and ST (HR: 0.39, 95% CI: 0.16-0.97, p = 0.004) were observed in the genotype-guided group compared to the STD group. No significant between-group difference was found for the risk of stroke, TVR, and major bleedings after the pooled analysis.
CONCLUSIONS : Genotype-guided antiplatelet treatment could decrease the risks of HTPR, all-cause mortality, MI and ST in patients with ACS or undergoing PCI.

Keywords

Acute coronary syndrome,CYP2C19,Genotype,P2Y12 inhibitors,Percutaneous coronary intervention,