Guided P2Y12 inhibitor selection after rapid CYP2C19 genotyping in patients undergoing percutaneous coronary intervention
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Dual antiplatelet therapy remains the standard treatment following percutaneous coronary intervention (PCI). While prasugrel and ticagrelor offer consistent antiplatelet effects, they increase bleeding risk compared with clopidogrel, which requires CYP2C19 bioactivation. AIMS: inhibitor selection and clinical outcomes in real-world patients. METHODS: inhibitor switching, major atherothrombotic events (MAE; a composite of all-cause death, myocardial infarction, ischaemic stroke, stent thrombosis, or unstable angina requiring revascularisation), and bleeding events were assessed throughout the first year post-PCI. Time-varying Cox regression analysis was performed to assess event risk in patients treated with clopidogrel (reference) versus prasugrel/ticagrelor after stratifying by loss-of-function (LOF) status and adjusting for stratum-specific confounders. RESULTS: inhibitor regimens after stratifying by LOF status (LOF-prasugrel/ticagrelor [n=147] vs LOF-clopidogrel [n=136]: adjusted hazard ratio [HR] 0.87 [95% confidence interval [CI]: 0.36-2.10]; non-LOF-prasugrel/ticagrelor [n=272] vs non-LOF-clopidogrel [n=419]: adjusted HR 1.26, 95% CI: 0.67-2.36). No significant differences in Bleeding Academic Research Consortium bleeding events were observed. CONCLUSIONS: This real-world study shows that, among LOF carriers managed with rapid CYP2C19 genotyping and delayed de-escalation, ischaemic and bleeding event rates were not significantly different between those taking clopidogrel versus those taking prasugrel/ticagrelor, though findings should be interpreted cautiously.
Source: EuroIntervention
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7223664625