Scientific Poster Session I - Original Research

Original Research
  Saturday, October 12, 2024
  11:30 AM–01:00 PM

Abstract

Introduction: CYP2C19 genotype-guided antiplatelet therapy (APT) improves outcomes after percutaneous coronary intervention (PCI). However, patients with high bleeding risk (HBR) have been underrepresented in genotype-guided APT randomized trials.

Research Question or Hypothesis: How does HBR impact genotype-guided APT use and clinical outcomes after PCI?

Study Design: Single-center retrospective cohort study

Methods: Adult patients who underwent PCI and CYP2C19 testing from 2012-2019 were included (n=1895). Prasugrel or ticagrelor (prasugrel/ticagrelor) was recommended over clopidogrel in CYP2C19 intermediate or poor metabolizers (IM/PMs). HBR status was defined using modified Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria. The composite of either a major atherothrombotic event (MAE: death, myocardial infarction, ischemic stroke, stent thrombosis, or revascularization for unstable angina) or bleeding event (GUSTO moderate or severe) 1-year post-PCI was compared across CYP2C19-APT groups using multivariable Cox regression after stratifying by HBR status.

Results: The population included 755 (39.8%) HBR patients; of which, 249 (33.0%) were IM/PMs. Among IM/PMs, prasugrel/ticagrelor was used less frequently in HBR compared to non-HBR patients (49.0% vs. 72.0%, p<0.001). Among HBR patients, MAE rates were lower in prasugrel/ticagrelor versus clopidogrel-treated IM/PMs (13.1 vs. 37.2 per 100-person-years; adjusted HR 0.38, 95% CI 0.18-0.83, p=0.015); bleeding rates were not significantly different (13.3 vs. 8.7 per 100-person-years; adjusted HR 1.95, 95% CI 0.59-6.47, p=0.276). In IM/PMs, net MAE or bleed rates were not significantly different in prasugrel/ticagrelor versus clopidogrel-treated HBR patients (26.7 vs. 39.8 per 100-person-years; adjusted HR 0.69, 95% CI 0.37-1.30, p=0.248) and non-HBR patients (9.9 vs. 19.7 per 100-person-years; adjusted HR 0.66, 95% CI 0.29-1.50, p=0.318); although, there was a trend toward lower net rates in HBR and non-HBR patients.

Conclusion: CYP2C19 IM/PMs with HBR were less likely to receive prasugrel/ticagrelor. Although the results suggest prasugrel/ticagrelor use in IM/PMs may still derive net benefit, larger multicenter studies are needed to assess the clinical utility of genotype-guided APT in HBR patients.

Presenting Author

Ashton Pearce PharmD, MSCR
University of North Carolina at Chapel Hill

Authors

Craig R. Lee PharmD, PhD, FCCP
UNC Eshelman School of Pharmacy, UNC-Chapel Hill

Joseph S. Rossi MD, MSCI
UNC Medical Center

George A. Stouffer MD
UNC School of Medicine

Kayla Tunehag PharmD, MSPH
University of North Carolina at Chapel Hill