09/03/2019 | Press release | Distributed by Public on 09/03/2019 09:44
Contribution To Literature:
The POPular Genetics trial showed that a genotype-guided strategy was noninferior for net outcomes (ischemia/bleeding) and superior for bleeding (mostly minor bleeding).
The goal of the trial was to evaluate a genotype-guided strategy for selection of oral P2Y12 inhibitor compared with standard therapy with ticagrelor or prasugrel among patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).
Patients undergoing primary PCI for STEMI were randomized to a genotype-guided strategy for selection of oral P2Y12 inhibitor (n = 1,242) versus standard therapy with ticagrelor or prasugrel (n = 1,246).
In the genotype-guided group, detection of CYP2C19*2 or CYP2C19*3 resulted in the use of ticagrelor or prasugrel. Otherwise patients received clopidogrel.
The primary net outcome of death, MI, stroke, stent thrombosis, or major bleeding (PLATO criteria) at 12 months occurred in 5.1% of the genotype-guided group compared with 5.9% of the standard care group (p for noninferiority < 0.001).
Major or minor bleeding (PLATO criteria) at 12 months occurred in 9.8% of the genotype-guided group compared with 12.5% of the standard care group (p = 0.04).
Among patients with STEMI undergoing primary PCI, a genotype-guided strategy vs. standard of care was associated with noninferiority with respect to a net composite outcome. A genotype-guided strategy was associated with superiority with respect to major or minor bleeding. However, a genotype-guided strategy was not associated with a reduction in major bleeding as defined by three criteria.
Claassens DM, Vos GJ, Bergmeyer TO, et al. A Genotype-Guided Strategy for Oral P2Y12 Inhibitors in Primary PCI (POPular Genetics). N Engl J Med 2019;Sep 3:[Epub ahead of print].
Presented by Dr. Danny Claassens at the European Society of Cardiology Congress, Paris, France, September 3, 2019.
Keywords:ESC Congress, ESC 19, Acute Coronary Syndrome, Adenosine, Anticoagulants, Genotype, Genotyping Techniques, Hemorrhage, Myocardial Infarction, Percutaneous Coronary Intervention, Standard of Care, Stents, Stroke, Thrombosis