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Background <p>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.</p> Methods <p>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.</p> Results <p>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).</p> Conclusion <p>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.</p>

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

  • 期刊论文

  • 发表日期：

    2025年8月11日

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  • 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

摘要

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.