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. 2024 Aug;17(8):e70004.
doi: 10.1111/cts.70004.

Precision Antiplatelet Therapy after Percutaneous Coronary Intervention (Precision PCI) Registry - Informing optimal antiplatelet strategies

Larisa H Cavallari  1 , Craig R Lee  2   3 , Francesco Franchi  4 , Ellen C Keeley  5 , Joseph S Rossi  3 , Cameron D Thomas  1 , Yan Gong  1 , Caitrin W McDonough  1 , Petr Starostik  6 , Maryam J Al Saeed  1 , Latonya Been  4 , Natasha Kulick  2   3 , Jean Malave  1 , Ian R Mulrenin  2 , Anh B Nguyen  2 , Joshua N Terrell  1 , Grace Tillotson  2 , Amber L Beitelshees  7 , Almut G Winterstein  8 , George A Stouffer  3 , Dominick J Angiolillo  4
Affiliations

Precision Antiplatelet Therapy after Percutaneous Coronary Intervention (Precision PCI) Registry - Informing optimal antiplatelet strategies

Larisa H Cavallari et al. Clin Transl Sci. 2024 Aug.

Abstract

Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor (clopidogrel, prasugrel, or ticagrelor) is indicated after percutaneous coronary intervention (PCI) to reduce the risk of atherothrombotic events. Approximately 30% of the US population has a CYP2C19 no-function allele that reduces the effectiveness of clopidogrel, but not prasugrel or ticagrelor, after PCI. We have shown improved outcomes with the integration of CYP2C19 genotyping into clinical care to guide the selection of prasugrel or ticagrelor in CYP2C19 no-function allele carriers. However, the influence of patient-specific demographic, clinical, and other genetic factors on outcomes with genotype-guided DAPT has not been defined. In addition, the impact of genotype-guided de-escalation from prasugrel or ticagrelor to clopidogrel in patients without a CYP2C19 no-function allele has not been investigated in a diverse, real-world clinical setting. The Precision Antiplatelet Therapy after Percutaneous Coronary Intervention (Precision PCI) Registry is a multicenter US registry of patients who underwent PCI and clinical CYP2C19 testing. The registry is enrolling a diverse population, assessing atherothrombotic and bleeding events over 12 months, collecting DNA samples, and conducting platelet function testing in a subset of patients. The registry aims to define the influence of African ancestry and other patient-specific factors on clinical outcomes with CYP2C19-guided DAPT, evaluate the safety and effectiveness of CYP2C19-guided DAPT de-escalation following PCI in a real-world setting, and identify additional genetic influences of clopidogrel response after PCI, with the ultimate goal of establishing optimal strategies for individualized antiplatelet therapy that improves outcomes in a diverse, real-world population.

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Conflict of interest statement

F.F. has received consulting fees or honoraria from AstraZeneca; his institution has received research grants from PLx Pharma and the Scott R. MacKenzie Foundation. P.S. has received consulting fees from Medosome Biotech; A.G.W has received consulting fees from Arbor Pharmaceuticals, Bayer KG, Ipsen Pharmaceuticals and Genentech. Her institution has received funding for research for which she served as principal investigator from Merck, Sharpe and Dohme. D.J.A. has received consulting fees or honoraria from Abbott, Amgen, Aralez, AstraZeneca, Bayer, Biosensors, Boehringer Ingelheim, Bristol Myers Squibb, Chiesi, Daiichi‐Sankyo, Eli Lilly, Faraday, Haemonetics, Janssen, Merck, Novartis, NovoNordisk, PhaseBio, PLx Pharma, Pfizer, Sanofi, and Vectura; his institution has received research grants from Amgen, AstraZeneca, Bayer, Biosensors, CeloNova, CSL Behring, Daiichi‐Sankyo, Eisai, Eli Lilly, Faraday, Gilead, Idorsia, Janssen, Matsutani Chemical Industry Co, Merck, Novartis, Osprey Medical, Renal Guard Solutions, and the Scott R. MacKenzie Foundation. All other authors declared no competing interests for this work.

Figures

FIGURE 1
FIGURE 1
Precision PCI study cohort. DAPT, dual antiplatelet therapy; EHR, electronic health record; PCI, percutaneous coronary intervention; PFT, platelet function testing.
FIGURE 2
FIGURE 2
Data collection. DAPT, dual antiplatelet therapy; MI, myocardial infarction; PCI, percutaneous coronary intervention.
See this image and copyright information in PMC

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