Real-World Implementation of a Genotype-Guided P2Y12 Inhibitor De-Escalation Strategy in Acute Coronary Syndrome Patients
Authors' conclusion
The implementation of a CYP2C19 genotype-guided P2Y12 inhibitor de-escalation strategy in a real-world ACS population resulted in lower bleeding rates without an increase in ischemic events compared to a standard DAPT regimen.
Study context
- Population
- Acute coronary syndrome (ACS) patients in the FORCE-ACS registry
- Participants
- 5,321 patients
- Exposure
- CYP2C19 genotype-guided P2Y12 inhibitor de-escalation vs standard dual antiplatelet therapy (DAPT)
- Genotypedn = 406
- Standard caren = 4,915reference
- Outcome
- Primary ischemic endpoint (CV mortality, MI or stroke) and primary bleeding endpoint (BARC 2, 3 or 5 bleeding)
- Follow-up
- 1 year
Methodological detailsmulticentre registry, genotype-guided strategy at a single centre
- Multicentre registry
- Genotype-guided strategy at a single centre
Main finding
As reported in the abstract
Genotyped
- Ischemic endpoint
- 5.2% (n = 21)
- Bleeding (BARC 2, 3 or 5)
- 4.7%
Standard care
- Ischemic endpoint
- 6.9% (n = 337)
- Bleeding (BARC 2, 3 or 5)
- 9.8%
Ischemic endpoint
Genotyped5.2% (n = 21)
Standard care6.9% (n = 337)
Bleeding (BARC 2, 3 or 5)
Genotyped4.7%
Standard care9.8%
Genotyped vs Standard careAdjusted hazard ratio (95% CI)
Primary ischemic endpoint
0.82(0.53–1.28)
Primary bleeding endpoint
0.47(0.30–0.76)
Observational data: associations, not effects.
Further findings
- CYP2C19 noncarriers in genotyped cohort
- 65.3% · 265 of 406
Safety
| Outcome | Genotyped | Standard care | Adjusted HR (95% CI) | |
|---|---|---|---|---|
| Primary bleeding endpoint (BARC 2, 3 or 5) · 1 year | 4.7% | 9.8% | 0.47 (0.30–0.76) | |
| 0.20.5125Adjusted hazard ratio (log scale) |
Original publication
Real-World Implementation of a Genotype-Guided P2Y12 Inhibitor De-Escalation Strategy in Acute Coronary Syndrome Patients. JACC Cardiovasc Interv. Published 29 July 2024. doi:10.
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