title: Results of genotype-guided antiplatelet therapy in patients who undergone percutaneous coronary intervention with stent.
abstract: BACKGROUND
  Clopidogrel has provided beneficial effects in acute coronary syndrome and percutaneous coronary intervention. Different polymorphisms have been associated with differences in clopidogrel response. The aim of this study was to check if CYP2C19/ABCB1-genotype-guided strategy reduces the rates of cardiovascular events and bleeding.
  
  
  METHODS
  This experimental study included patients undergoing percutaneous coronary intervention with stent. The prospective genotype-guided strategy (intervention group) was compared against a retrospective non-tailored strategy (control group). Primary efficacy endpoint was the composite of cardiovascular death, acute coronary syndrome or stroke during 12months after intervention. Secondary endpoint was to compare the efficacy of the different antiplatelet therapies used in genotyping conditions.
  
  
  RESULTS
  The study included 719 patients undergone stent, more than 86% with acute coronary syndrome. The primary endpoint occurred in 32 patients (10.1%) in the genotyping group and in 59 patients (14.1%) in the control group (HR 0.63, 95% CI (0.41-0.97), p =0.037). There was no difference in The Thrombolysis in Myocardial Infarction major and minor bleeding criteria between the two groups (4.1% vs. 4.7%, HR=0.80, 95% CI (0.39-1.63), p=0.55). In intervention group, there was no difference in the rate of events in patients treated with clopidogrel versus patients treated with other antiplatelet treatments (9.1% vs 11.5% p=0.44), or bleeding (3.7% vs 4.6%, p=0.69).
  
  
  CONCLUSIONS
  The genotype-guided strategy could reduce the rates of composite of cardiovascular events and bleeding during 12months after percutaneous coronary intervention compared to a non-genotype-guide strategy.
authors.affiliation: Department of Cardiology, Granada University Hospital, Institute for biomedical research, ibs.GRANADA, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Sánchez-Ramos
authors.affiliation: Department of Clinical Pharmacy, Granada University Hospital, Institute for biomedical research, ibs.GRANADA, Spain. Electronic address: cristinal.davila.sspa@juntadeandalucia.es.
authors.forename: Cristina Lucía
authors.initials: CL
authors.lastname: Dávila-Fajardo
authors.affiliation: Department of Cardiology, Granada University Hospital, Institute for biomedical research, ibs.GRANADA, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Toledo Frías
authors.affiliation: Department of Clinical Pharmacy, Granada University Hospital, Institute for biomedical research, ibs.GRANADA, Spain.
authors.forename: Xando
authors.initials: X
authors.lastname: Díaz Villamarín
authors.affiliation: Genomics Unit, Centre for Genomics and Oncological Research (GENYO), Pfizer-University of Granada-Andalusian Regional Government, Health Sciences Technology Park, Granada, Spain.
authors.forename: Luis Javier
authors.initials: LJ
authors.lastname: Martínez-González
authors.affiliation: Department of Cardiology, Granada University Hospital, Institute for biomedical research, ibs.GRANADA, Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: Martínez Huertas
authors.affiliation: Department of Cardiology, Granada University Hospital, Institute for biomedical research, ibs.GRANADA, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Burillo Gómez
authors.affiliation: Department of Cardiology, Granada University Hospital, Institute for biomedical research, ibs.GRANADA, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Caballero Borrego
authors.affiliation: Department of Cardiology, Granada University Hospital, Institute for biomedical research, ibs.GRANADA, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Bautista Pavés
authors.affiliation: Department of Cardiology, Granada University Hospital, Institute for biomedical research, ibs.GRANADA, Spain.
authors.forename: Mª Carmen
authors.initials: MC
authors.lastname: Marín Guzmán
authors.affiliation: Department of Cardiology, Granada University Hospital, Institute for biomedical research, ibs.GRANADA, Spain.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Ramirez Hernández
authors.affiliation: Department of Cardiology, Granada University Hospital, Institute for biomedical research, ibs.GRANADA, Spain.
authors.forename: Concepción
authors.initials: C
authors.lastname: Correa Vilches
authors.affiliation: Department of Clinical Pharmacy, Granada University Hospital, Institute for biomedical research, ibs.GRANADA, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Cabeza Barrera
mesh_terms: D018435:ATP Binding Cassette Transporter, Subfamily B / Q000235:genetics; D054058:Acute Coronary Syndrome / Q000235:genetics / Q000401:mortality / Q000628:therapy; D000368:Aged; D065731:Cytochrome P-450 CYP2C19 / Q000235:genetics*; D003643:Death; D005260:Female; D005500:Follow-Up Studies; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods / Q000401:mortality / Q000639:trends*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011446:Prospective Studies; D012189:Retrospective Studies; D015607:Stents
chemical_list: C513055:ABCB1 protein, human; D018435:ATP Binding Cassette Transporter, Subfamily B; D010975:Platelet Aggregation Inhibitors; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19
keywords: ABCB1; CYP2C19; Clopidogrel; Genotype-guided antiplatelet therapy