What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Coronary artery disease (CAD) after percutaneous coronary intervention (PCI) (n=4604). Intervention: Genotype-guided antiplatelet therapy vs. Standard treatment. Primary outcome: Major adverse cardiovascular events (MACE) (OR 0.52, 95% CI 0.35-0.78, p=0.001).

April 30, 2026Die Pharmazie0 citationsOpen Access

Efficacy and safety of genotype-guided antiplatelet therapy versus standard treatment in 4,604 patients with CAD after PCI: a meta-analysis of randomized controlled trials

DLDi Liu YLYun Zhao Li HWHui Wu

Key Result

Genotype-guided antiplatelet therapy reduced the risk of major adverse cardiovascular events (OR 0.52) compared with standard treatment in patients with CAD after PCI.

Key Points

This research aims to evaluate the efficacy and safety of genotype-guided antiplatelet therapy versus standard treatment in CAD patients post-PCI.
Conducted a meta-analysis of randomized controlled trials published until August 2020.
Searched databases included Medline, Embase, and Cochrane Library.
Data analyzed using RevMan 5.3 software with quality assessed by Cochrane's tool.
Genotype-guided therapy reduced the risk of major adverse cardiovascular events (OR=0.52, 95%CI:0.35-0.78, P=0.001).
Reduced risk of myocardial infarction (OR=0.48, 95%CI:0.33-0.68, P<0.0001) and any bleeding (OR=0.77, 95%CI:0.62-0.95, P=0.02).
No significant differences found in overall mortality (OR=0.53, P=0.25) or major bleeding events (OR=0.86, P=0.47).

Study Design

Type

Meta-Analysis (n=4,604)

Structured PICO

Does genotype-guided antiplatelet therapy reduce major adverse cardiovascular events and bleeding in patients with CAD after PCI?

Population

4 RCTs pooling 4,604 patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI).

Intervention

Genotype-guided antiplatelet therapy (switching from clopidogrel to ticagrelor or prasugrel for CYP2C19 loss-of-function allele carriers, or adding cilostazol).

Comparator

Standard antiplatelet treatment (predominantly clopidogrel).

Outcome

Major adverse cardiovascular events (MACE), defined as a composite of death of all cause, myocardial infarction (MI), stroke, and target vessel revascularization.composite

Genotype-guided antiplatelet therapy significantly reduces the risk of MACE, myocardial infarction, and bleeding events compared to standard treatment in patients with CAD undergoing PCI.

Main Result

Effect estimate: OR 0.52 (95% CI 0.35-0.78)

p-value: p=0.001

Limitations

Few trials available to be included, requiring verification by more large-scale RCTs.
Study population was a mixed cohort of ACS and non-ACS, and subgroup analyses could not be performed due to lack of direct access to patient data.
Not possible to assess publication bias by funnel plots because of the insufficient number of eligible studies (n<10).

Abstract

Objective: To compare the efficacy and safety of genotype-guided antiplatelet strategy and standard treatment in patient with coronary artery disease (CAD) after percutaneous coronary intervention (PCI). Methods: Relevant studies published in Medline, Embase, CoChrane Library were searched for randomized controlled trials (RCTs) until August 2020. Studies were screened by selection criteria, quality assessed using the Cochrane Collaboration's tool. Data were extracted from the included studies and statistically analyzed by RevMan 5.3 software. Results: Four RCTs involving 4,604 patients were included in this meta-analysis. Compared with the standard treatment group, the pooled results showed that genotype-guided group associated with lower risk of major adverse cardiovascular events (MACE, OR=0.52, 95%CI:0.35-0.78, P =0.001), any bleeding (OR=0.77, 95%CI: 0.62-0.95, P =0.02) and myocardial infarction (MI, OR=0.48, 95%CI:0.33-0.68, P <0.0001). There was no significant difference in death of any cause (OR=0.53, 95%CI: 0.18-1.54, P =0.25), cardiovascular death (OR=0.74, 95%CI:0.48-1.14, P =0.17), target vessel revascularization (OR=0.66, 95%CI:0.39-1.12, P =0.12) and major bleeding events (OR=0.86, 95%CI: 0.58-1.28, P =0.47). Conclusion: Genotype guided antiplatelet therapy could reduce the risk of MACE, MI and any bleeding events in patients with CAD undergone PCI, compared with standard treatment. Therefore, the findings support that implementation of genotype testing to tailor antiplatelet therapy after PCI.

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