Genotype‐guided antiplatelet treatment bests conventional therapy in averting MACE, MI

In patients with coronary artery disease or undergoing percutaneous coronary intervention, genotype-guided antiplatelet treatment may reduce the risk of major adverse cardiovascular events (MACE), stent thrombosis, and myocardial infarction (MI) without increasing the risk of bleeding over a long follow-up period, results of a recent study have shown.

The investigators searched the databases of PubMed, Web of Science, Embase, and the Cochrane Library from inception to 5 May 2020 for studies reporting endpoints in genotype-guided treatment and conventional treatment groups. Then, they presented the endpoint results as the risk ratio (RR) with 95 percent confidence interval (CI).

Sixteen studies including a total of 10,561 patients were included in the meta-analysis. Of these, eight were randomized controlled trials (RCTs) and eight were cohort studies.

Patients in the genotype-guided arm had significantly lower rates of MACE (RR, 0.56, 95 percent CI, 0.44–0.73; p<0.001), stent thrombosis (RR, 0.40, 95 percent CI, 0.24–0.67; p=0.0005), and MI (RR, 0.45, 95 percent CI, 0.35–0.58; p<0.00001) compared to those in the conventional treatment arm. Of note, a significant between-group difference was observed in major bleeding (RR, 0.73, 95 percent CI, 0.55–0.98; p=0.04), which was not robust after sensitivity analysis.

“The decreased risk of efficacy outcomes was more obvious in cohort studies,” the investigators noted. “Well‐organized RCTs and clinical trials are required to verify the benefit of genotype‐guided therapy.”