Details

Autor(en) / Beteiligte

• Cavallari, Larisa H.
• Lee, Craig R.
• Beitelshees, Amber L.
• Cooper-DeHoff, Rhonda M.
• Duarte, Julio D.
• Voora, Deepak
• Kimmel, Stephen E.
• McDonough, Caitrin W.
• Gong, Yan
• Dave, Chintan V.
• Pratt, Victoria M.
• Alestock, Tameka D.
• Anderson, R. David
• Alsip, Jorge
• Ardati, Amer K.
• Brott, Brigitta C.
• Brown, Lawrence
• Chumnumwat, Supatat
• Clare-Salzler, Michael J.
• Coons, James C.
• Denny, Joshua C.
• Dillon, Chrisly
• Elsey, Amanda R.
• Hamadeh, Issam S.
• Harada, Shuko
• Hillegass, William B.
• Hines, Lindsay
• Horenstein, Richard B.
• Howell, Lucius A.
• Jeng, Linda J.B.
• Kelemen, Mark D.
• Lee, Yee Ming
• Magvanjav, Oyunbileg
• Montasser, May
• Nelson, David R.
• Nutescu, Edith A.
• Nwaba, Devon C.
• Pakyz, Ruth E.
• Palmer, Kathleen
• Peterson, Josh F.
• Pollin, Toni I.
• Quinn, Alison H.
• Robinson, Shawn W.
• Schub, Jamie
• Skaar, Todd C.
• Smith, D. Max
• Sriramoju, Vindhya B.
• Starostik, Petr
• Stys, Tomasz P.
• Stevenson, James M.
• Varunok, Nicholas
• Vesely, Mark R.
• Wake, Dyson T.
• Weck, Karen E.
• Weitzel, Kristin W.
• Wilke, Russell A.
• Willig, James
• Zhao, Richard Y.
• Kreutz, Rolf P.
• Stouffer, George A.
• Empey, Philip E.
• Limdi, Nita A.
• Shuldiner, Alan R.
• Winterstein, Almut G.
• Johnson, Julie A.

Titel

Multisite Investigation of Outcomes With Implementation of CYP2C19 Genotype-Guided Antiplatelet Therapy After Percutaneous Coronary Intervention

Ist Teil von

• JACC. Cardiovascular interventions, 2018-01, Vol.11 (2), p.181-191

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2018

Quelle

Elsevier ScienceDirect Journals

Beschreibungen/Notizen

• This multicenter pragmatic investigation assessed outcomes following clinical implementation of CYP2C19 genotype–guided antiplatelet therapy after percutaneous coronary intervention (PCI). CYP2C19 loss-of-function alleles impair clopidogrel effectiveness after PCI. After clinical genotyping, each institution recommended alternative antiplatelet therapy (prasugrel, ticagrelor) in PCI patients with a loss-of-function allele. Major adverse cardiovascular events (defined as myocardial infarction, stroke, or death) within 12 months of PCI were compared between patients with a loss-of-function allele prescribed clopidogrel versus alternative therapy. Risk was also compared between patients without a loss-of-function allele and loss-of-function allele carriers prescribed alternative therapy. Cox regression was performed, adjusting for group differences with inverse probability of treatment weights. Among 1,815 patients, 572 (31.5%) had a loss-of-function allele. The risk for major adverse cardiovascular events was significantly higher in patients with a loss-of-function allele prescribed clopidogrel versus alternative therapy (23.4 vs. 8.7 per 100 patient-years; adjusted hazard ratio: 2.26; 95% confidence interval: 1.18 to 4.32; p = 0.013). Similar results were observed among 1,210 patients with acute coronary syndromes at the time of PCI (adjusted hazard ratio: 2.87; 95% confidence interval: 1.35 to 6.09; p = 0.013). There was no difference in major adverse cardiovascular events between patients without a loss-of-function allele and loss-of-function allele carriers prescribed alternative therapy (adjusted hazard ratio: 1.14; 95% confidence interval: 0.69 to 1.88; p = 0.60). These data from real-world observations demonstrate a higher risk for cardiovascular events in patients with a CYP2C19 loss-of-function allele if clopidogrel versus alternative therapy is prescribed. A future randomized study of genotype-guided antiplatelet therapy may be of value. [Display omitted]