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

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 metabolizers (homozygous variant AA) (19%). Dual antiplatelets were given based on the genotyping data. Poor metabolizers received newer agent (ticagrelor), intermediate metabolizers received double-dose of clopidogrel and normal metabolizers 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’ metabolizers (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.