Optimizing P2Y12 Inhibitor Therapy in Post-PCI Patients Through Genotype-Guided Strategies: A Systematic Review and Meta-Analysis.

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Drugs and Therapy Pub Date : 2025-08-11 DOI:10.1007/s10557-025-07747-5

Mohammad Hamza, Mubashar Karamat, Khaled M Harmouch, Sardar M Alamzaib, Sidra Jabeen, Jawad Basit, Karan Bhanushali, Rohan Ved, Amna Rashdi, Muhammad Usman Almani, Moinuddin Syed, Yasar Sattar, M Chadi Alraies

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引用次数: 0

Abstract

Background: Clopidogrel non-responder is a common dilemma in the management of post-percutaneous coronary intervention (PCI) management. Clopidogrel is metabolized by CYP2C19. The genetic variations in CYP2C19 can affect the efficacy and bioavailability of the drug that can be checked via genotype testing of the gene. This study evaluates the impact of genotype versus conventional guided P2Y12 inhibitor therapy on post-PCI patient outcomes.

Methods: Guided by PRISMA and AMSTAR-2, we analyzed 10 trials comparing genotype-guided and conventional P2Y12 inhibitor therapy in post-PCI patients. Our search, spanning up to October 2022 across major databases, focused on adult populations undergoing PCI, assessing outcomes like mortality, MACE, myocardial infarction, stroke, stent thrombosis, and bleeding events.

Results: A total of 10 studies involving 4300 patients were selected in pooled analysis, genotype-guided therapy markedly reduced all-cause mortality (RR: 0.59; 95% CI: 0.37-0.95) and MACE (RR: 0.66; 95% CI: 0.49-0.88), without a significant increase in bleeding events (RR: 0.83; 95% CI: 0.61-1.14). Furthermore, significant reductions were observed in myocardial infarction (RR: 0.59; 95% CI: 0.44-0.78) and stent thrombosis (RR: 0.55; 95% CI: 0.3-0.996), with stroke also seeing a decrease (RR: 0.56; 95% CI: 0.35-0.9).

Conclusion: Genotype-guided P2Y12 inhibitor therapy significantly improves outcomes for post-PCI patients, reducing mortality, MACE, myocardial infarction, and stent thrombosis without increasing bleeding risk. These findings support the integration of genetic testing into clinical decision-making for DAPT optimization.

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通过基因型引导策略优化pci后患者P2Y12抑制剂治疗：系统回顾和荟萃分析

背景：氯吡格雷无效是经皮冠状动脉介入治疗（PCI）后常见的难题。氯吡格雷由CYP2C19代谢。CYP2C19基因变异会影响药物的疗效和生物利用度，可通过基因型检测来检测。本研究评估基因型与传统引导P2Y12抑制剂治疗对pci后患者预后的影响。方法：在PRISMA和AMSTAR-2的指导下，我们分析了10项比较基因型引导和常规P2Y12抑制剂治疗pci后患者的试验。我们的搜索跨越了主要数据库，截止到2022年10月，重点关注了接受PCI的成人人群，评估了死亡率、MACE、心肌梗死、中风、支架血栓形成和出血事件等结果。结果：共纳入10项研究，共纳入4300例患者，基因型引导治疗可显著降低全因死亡率(RR: 0.59；95% CI: 0.37-0.95)和MACE (RR: 0.66；95% CI: 0.49-0.88)，出血事件无显著增加(RR: 0.83；95% ci: 0.61-1.14)。此外，心肌梗死显著降低(RR: 0.59；95% CI: 0.44-0.78)和支架内血栓形成(RR: 0.55；95% CI: 0.3-0.996)，中风也有下降(RR: 0.56；95% ci: 0.35-0.9)。结论：基因型引导的P2Y12抑制剂治疗可显著改善pci后患者的预后，降低死亡率、MACE、心肌梗死和支架血栓形成，而不增加出血风险。这些发现支持将基因检测整合到DAPT优化的临床决策中。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cardiovascular Drugs and Therapy 医学-心血管系统

CiteScore

8.30

自引率

0.00%

发文量

110

审稿时长

4.5 months

期刊介绍： Designed to objectively cover the process of bench to bedside development of cardiovascular drug, device and cell therapy, and to bring you the information you need most in a timely and useful format, Cardiovascular Drugs and Therapy takes a fresh and energetic look at advances in this dynamic field. Homing in on the most exciting work being done on new therapeutic agents, Cardiovascular Drugs and Therapy focusses on developments in atherosclerosis, hyperlipidemia, diabetes, ischemic syndromes and arrhythmias. The Journal is an authoritative source of current and relevant information that is indispensable for basic and clinical investigators aiming for novel, breakthrough research as well as for cardiologists seeking to best serve their patients. Providing you with a single, concise reference tool acknowledged to be among the finest in the world, Cardiovascular Drugs and Therapy is listed in Web of Science and PubMed/Medline among other abstracting and indexing services. The regular articles and frequent special topical issues equip you with an up-to-date source defined by the need for accurate information on an ever-evolving field. Cardiovascular Drugs and Therapy is a careful and accurate guide through the maze of new products and therapies which furnishes you with the details on cardiovascular pharmacology that you will refer to time and time again.