Coronary disease & ACSCohort study
Effectiveness of Clopidogrel vs Alternative P2Y12 Inhibitors Based on the ABCD-GENE Score
- Cohort study
- stabilized inverse probability weighting
Authors' conclusion
These data support the use of alternative therapy over clopidogrel in CYP2C19 LOF allele carriers after PCI, regardless of ABCD-GENE score, while clopidogrel is as effective as alternative therapy in non-LOF patients with scores <10.
Study context
- Population
- Patients after percutaneous coronary intervention (PCI) with CYP2C19 genotyping and P2Y12 inhibitor treatment
- Participants
- 4,335 patients
- Exposure
- Alternative P2Y12 inhibitor vs clopidogrel, by ABCD-GENE score
- Outcome
- Major atherothrombotic events (MAE)
- Follow-up
- 1 year after PCI
Main finding
As reported in the abstract
MAE by ABCD-GENE score
Alternative therapy vs ClopidogrelWeighted hazard ratio (95% CI)P value
score <10 (n = 3,200)
0.89(0.65–1.22)
P = 0.475score ≥10 (n = 1,135)
0.75(0.51–1.11)
P = 0.155Observational data: associations, not effects.
Further findings
| Outcome | weighted HR (95% CI) | P value | |
|---|---|---|---|
| MAE by ABCD-GENE score and CYP2C19 LOF genotype (subgroup) — Alternative therapy vs Clopidogrel · LOF carriers, score <10 | 0.50 (0.25–1.01) | P = 0.052 | |
| MAE by ABCD-GENE score and CYP2C19 LOF genotype (subgroup) — Alternative therapy vs Clopidogrel · LOF carriers, score ≥10 | 0.48 (0.29–0.80) | P = 0.004 | |
| MAE by ABCD-GENE score and CYP2C19 LOF genotype (subgroup) — Alternative therapy vs Clopidogrel · no LOF alleles, score <10 | 1.03 (0.70–1.51) | P = 0.885 | |
| 0.20.5125Weighted hazard ratio (log scale) |
Original publication
Effectiveness of Clopidogrel vs Alternative P2Y12 Inhibitors Based on the ABCD-GENE Score. J Am Coll Cardiol. Published 16 April 2024. doi:10.1016/j.jacc.2024.02.015
Summarised from the published abstract; every number is checked against it