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. 2020 Nov-Dec;72(6):589-592.
doi: 10.1016/j.ihj.2020.09.002. Epub 2020 Sep 9.

Incidence of major adverse cardiovascular events with genotype test guided antiplatelet treatment strategy after percutaneous coronary intervention

S Ramesh  1 , S Socrates  2 , M A Rajasekaran  2 , N Senguttuvan  2
Affiliations

Incidence of major adverse cardiovascular events with genotype test guided antiplatelet treatment strategy after percutaneous coronary intervention

S Ramesh et al. Indian Heart J. 2020 Nov-Dec.

Abstract

Objective: To estimate the incidence of major adverse cardiovascular events (MACE) with genotype test-guided antiplatelet therapy in patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome.

Methods: Patients who had undergone PCI for acute coronary syndrome as well as stable coronary artery disease were recruited. Salivary samples were obtained from these patients and genotyped for CYP2C19∗2, CYP2C19∗3 variations by sequencing method (GAAP x method). Patients were categorized as normal (GG, GG) (29%), intermediate (AG) (52%) or poor metabolizes (homozygous variant AA) (19%). Dual antiplatelets were given based on the genotyping data. Poor metabolizes received newer agent (ticagrelor), intermediate metabolizes received double-dose of clopidogrel and normal metabolizes received therapeutic doses of clopidogrel. All subjects were followed-up for six months.

Results: Based on the genotyping data of CYP2C19∗2 and CYP2C19∗3 variations, it was found that most patients were categorized as 'intermediate' (78, 51.65%), followed by 'normal' (43, 28.48%) and 'poor' metabolizes (30, 19.87%). Only 3 (1.5%) of 151 patients reported MACE at follow-up.

Conclusions: Genotyping for CYP2C19 variations to assess clopidogrel resistance in patients undergoing PCI and subsequent drug selection helps reduce MACE after coronary intervention.

Keywords: Antiplatelet; Clopidogrel; Coronary intervention; Genotyping.

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Conflict of interest statement

Declaration of competing interest All authors have none to declare.

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