AUTHOR=Shi Xiujin , Zhang Yunnan , Zhang Yi , Zhang Ru , Lin Baidi , Han Jialun , Li Wenzheng , Fang Zhenwei , Yan Jialin , Wang Yifan , Zheng Ze , Lv Yuan , Lin Yang 

TITLE=Personalized Antiplatelet Therapy Based on CYP2C19 Genotypes in Chinese ACS Patients Undergoing PCI: A Randomized Controlled Trial

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.676954

DOI=10.3389/fcvm.2021.676954

ISSN=2297-055X

ABSTRACT=Background The clinical benefits of cytochrome P450 (CYP) 2C19 genotype-guided antiplatelet
therapy in Asians remain unclear. In this study, we aimed to investigate the clinical outcomes of
pharmacogenomic antiplatelet therapy in Chinese patients.
Methods Patients with acute coronary syndrome planning to undergo percutaneous coronary
intervention were eligible for this study and were randomly divided into a genotype-guided
treatment (GT) group and routine treatment (RT) group, with a ratio of 2:1. Patients in the GT group
underwent CYP2C19 genotyping (*2 and *3 alleles), and the results were considered in selecting
P2Y12 receptor inhibitors. Patients in the RT group were treated with P2Y12 receptor inhibitors
according to their clinical characteristics. The primary endpoint was a composite of major adverse
cardiovascular or cerebrovascular events (MACCE). The secondary endpoint was significant
bleeding events.
Results Finally, 301 patients were enrolled; 75.1% were men and the mean age was 59.7 ± 9.8 years.
In total, 281 patients completed the follow-up procedure. The primary endpoint occurred in 16
patients, 6 patients in the GT group and 10 in the RT group. The GT group showed lower MACCE
rates than the RT group (6/189 vs. 10/92, 3.2% vs. 10.9%, hazard ratio: 0.281, 95% confidence
interval: 0.102–0.773, P=0.009). There was no statistically difference in significant bleeding events
between the GT and RT groups (4.2% vs. 3.3%, hazard ratio: 1.315, 95% confidence interval: 0.349–
4.956, P=0.685).
Conclusion Personalized antiplatelet therapy that is based on CYP2C19 genotypes could decrease
MACCE within a 12-month period in Chinese patients with acute coronary syndrome undergoing
percutaneous coronary intervention.