CYP2C19 pharmacogenetics versus standard of care dosing for selecting antiplatelet therapy in patients with coronary artery disease: A meta-analysis of randomized clinical trials.
Catheter Cardiovasc Interv
; 93(7): 1246-1252, 2019 06 01.
Article
en En
| MEDLINE
| ID: mdl-30403317
ABSTRACT
OBJECTIVES:
This study aimed to evaluate the efficacy and safety of personalized genotype-guided selection of antiplatelet therapy versus standard of care in patients undergoing percutaneous coronary intervention (PCI).BACKGROUND:
Clopidogrel is the most frequently used P2Y12 receptor antagonist in patients with coronary artery disease. However, genetic variations of clopidogrel are associated with inter-individual response variability which could limit its efficacy.METHODS:
Electronic databases were searched for all randomized clinical trials (RCTs) evaluating genotype-guided therapy versus standard of care in patients undergoing stent implantation. Aggregated risk ratios (RRs) and 95% CIs were calculated using a random-effects model.RESULTS:
We included 6 RCTs with a total of 2,371 patients. When compared with standard of care, the use of genotype-guided therapy did not significantly reduce major adverse cardiovascular events (MACE) (RR 0.67; 95% CI 0.35-1.27; P = 0.22). However, MACE was significantly reduced in the subset of trials which enrolled only acute coronary syndromes (ACS) (P < 0.01). In addition, there was a significant reduction in myocardial infarction in the genotype-guided group (RR 0.44; 95% CI 0.28-0.70; P < 0.01; I2 = 0%). Other clinical outcomes were not significantly different cardiovascular mortality (RR 0.68; 95% CI 0.27-1.74; P = 0.42), stroke (RR 0.62; 95% CI 0.23-1.65; P = 0.34), stent thrombosis (RR 0.37; 95% CI 0.13-1.06; P = 0.06), and bleeding (RR 0.68; 95% CI 0.43-1.06; P = 0.09).CONCLUSION:
In patients undergoing stent implantation, MACE with genotype-guided therapy was not significantly reduced; however, there was a signal towards reduction of MACE in ACS patients, as well as a lower rate of MI, though this will require further confirmation in adequately powered trials.Palabras clave
Texto completo:
1
Ejes tematicos:
Pesquisa_clinica
Banco de datos:
MEDLINE
Asunto principal:
Enfermedad de la Arteria Coronaria
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Inhibidores de Agregación Plaquetaria
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Intervención Coronaria Percutánea
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Citocromo P-450 CYP2C19
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Pruebas de Farmacogenómica
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Variantes Farmacogenómicas
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Clopidogrel
Tipo de estudio:
Clinical_trials
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Diagnostic_studies
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Etiology_studies
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Prognostic_studies
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Risk_factors_studies
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Systematic_reviews
Límite:
Humans
Idioma:
En
Año:
2019
Tipo del documento:
Article