Genotype-Guided vs Conventional Oral P2Y12 Inhibitors in Acute Coronary Syndrome: A Combined Analysis of TAILOR-PCI and POPular Genetics
Authors' conclusion
In ACS patients undergoing PCI, genotype-guided de-escalation reduces bleeding and NACE without increasing MACE, with the greatest benefit in the first 3 months post-PCI.
Study context
- Population
- Patients with acute coronary syndrome (ACS) undergoing percutaneous coronary interventions (PCI)
- Participants
- 6,734 patients · 2 RCTs
- Comparison
- Genotype-guided P2Y12 inhibitor selection vs conventional therapy
- Outcome
- Primary safety: time-to-first BARC type 2, 3 or 5 bleeding; primary efficacy: time-to-first MACE
- Follow-up
- 12 months
Pooled result
As reported in the abstract
BARC 2, 3 or 5 bleeding and MACE · 1 year
- No differences in primary safety or efficacy endpoints with overall guided vs conventional therapy
Further pooled results
| Outcome | Estimate |
|---|---|
| MI and NACE (overall guided therapy)Guided therapy vs Conventional therapy · MI | 0.68 (95% CI 0.48–0.97) |
| MI and NACE (overall guided therapy)Guided therapy vs Conventional therapy · NACE | 0.85 (95% CI 0.73–1.00) |
| Guided de-escalation subgroup: BARC 2, 3 or 5 bleeding, NACE, MACEGuided de-escalation vs Conventional therapy · primary safety endpoint (bleeding) | 0.77 (95% CI 0.62–0.97) |
| Guided de-escalation subgroup: BARC 2, 3 or 5 bleeding, NACE, MACEGuided de-escalation vs Conventional therapy · NACE | 0.77 (95% CI 0.62–0.94) |
Guided de-escalation subgroup: Bleeding Academic Research Consortium (BARC) 2, 3 or 5 bleeding, net adverse cardiovascular events (NACE), major adverse cardiovascular event (MACE)
- No significant difference in MACE
Guided escalation subgroup: primary safety and efficacy endpoints
- Similar to conventional therapy
Bleeding and NACE, time-dependent covariate analyses · before 90 days
- Overall guided therapy and de-escalation reduced bleeding and NACE vs conventional therapy
Original publication
Genotype-Guided vs Conventional Oral P2Y12 Inhibitors in Acute Coronary Syndrome: A Combined Analysis of TAILOR-PCI and POPular Genetics. JACC Cardiovasc Interv. Published 9 February 2026. doi:10.
Summarised from the published abstract; every number is checked against it