Genotype-Guided P2Y 12 -Inhibitor De-Escalation Strategy in Acute Coronary Syndrome: Observational Evidence From the POPular-GUIDE PCI
Authors' conclusion
In patients with acute coronary syndrome receiving antiplatelet therapy, implementation of a CYP2C19 genotype-guided de-escalation strategy in clinical practice was associated with a significant reduction of major and nonmajor clinically relevant bleeding compared with standard care at 12 months, without increasing ischemic events.
Study context
- Population
- Patients with acute coronary syndrome receiving antiplatelet therapypatients included in the analysis · genotype-guided cohort 1,208 · standard care cohort 8,699
- Participants
- 9,907 patients
- Exposure
- Genotype-guided therapy vs standard care
- genotype-guided cohortn = 1,208
- standard care cohortn = 8,699reference
- Outcome
- Coprimary end points: major adverse cardiac events (cardiovascular death, myocardial infarction, or stroke) and major or nonmajor clinically relevant bleeding
- Follow-up
- 1 year
Methodological detailsHazard ratios adjusted using multivariable Cox regression, Bonferroni-adjusted significance level of α =0.025
- Hazard ratios adjusted using multivariable Cox regression
- Bonferroni-adjusted significance level of α =0.025
Main finding
As reported in the abstract
Coprimary end points: major adverse cardiac events (cardiovascular death, myocardial infarction, or stroke) and major or nonmajor clinically relevant bleeding
Genotype-guided cohort
- Major adverse cardiac events
- 107 patients (8.9%)
- Major or nonmajor clinically relevant bleeding
- 146 patients (12.1%)
Standard care cohort
- Major adverse cardiac events
- 897 patients (10.3%)
- Major or nonmajor clinically relevant bleeding
- 1384 patients (15.9%)
Major adverse cardiac events
Genotype-guided cohort107 patients (8.9%)
Standard care cohort897 patients (10.3%)
Major or nonmajor clinically relevant bleeding
Genotype-guided cohort146 patients (12.1%)
Standard care cohort1384 patients (15.9%)
genotype-guided cohort vs standard care cohortAdjusted hazard ratio (95% CI)P value
Major adverse cardiac events
1.05(0.85–1.29)
P = 0.64Major or nonmajor clinically relevant bleeding
0.79(0.67–0.94)
P = 0.01Observational data: associations, not effects.
Further findings
| Outcome | Adjusted hazard ratio (95% CI) | P value | |
|---|---|---|---|
| Net adverse cardiac events (all-cause death, myocardial infarction, stroke, stent thrombosis, and major bleeding) · no significant association | 0.91 (0.76–1.09) | P = 0.31 | |
| 0.512Adjusted hazard ratio (log scale) |
Original publication
Genotype-Guided P2Y 12 -Inhibitor De-Escalation Strategy in Acute Coronary Syndrome: Observational Evidence From the POPular-GUIDE PCI. Circ Cardiovasc Interv. Published 26 February 2026. doi:10.
Summarised from the published abstract; every number is checked against it