Genotype-guided antiplatelet therapy compared with standard therapy for patients with acute coronary syndromes or undergoing percutaneous coronary intervention: A systematic review and meta-analysis

Objective: To determine, in patients with acute coronary syndromes (ACS) or undergoing percutaneous coronary intervention (PCI), the effectiveness and safety between personalized P2Y12 inhibitors treatment based on genotypes and standard treatment.

Methods: We systematically searched for articles from PubMed, Cochrane Library, Embase and Web of science from their inception to March 4, 2020, with no language restrictions. The search was performed to identify all randomized clinical trials (RCTs) in which genotype-guided versus standard treatment with P2Y12 inhibitors among patients with ACS or those undergoing PCI. The primary clinical outcomes were major adverse cardiovascular events (MACEs) including death, myocardial infarction (MI), stroke, stent thrombosis (ST), and targeted vessel revascularization (TVR). The secondary outcomes were high on-treatment platelet reactivity (HTPR) and safety outcomes including major bleeding events.

Results: A total of 4859 patients from 7 RCTs were included in the meta-analysis. There were 2430 patients (50.01%) allocated to the genotype-guided group and 2429 (49.99%) allocated to the standard group. Pooled result showed that compared with the standard treatment group, the genotype-guided group had a significantly lower risk of HTPR (Risk Ratio [RR]: 0.35, 95% confidence interval [CI]: 0.14-0.83, P = 0.02, I² = 58%), MI (RR: 0.52, 95% CI: 0.36-0.74, P = 0.0004, I² = 0%) and ST (RR: 0.41, 95% CI: 0.17-0.98, P = 0.05, I² = 0%). No significant difference was found between two groups for the risk of death (RR: 0.78, 95% CI: 0.54-1.12, P = 0.18, I² = 34%), stroke (RR = 0.67, 95% CI: 0.35-1.30, P = 0.24, I² = 0%), TVR (RR: 0.83, 95% CI: 0.46-1.50, P = 0.54, I² = 0%) and major bleeding events (RR: 0.83, 95% CI: 0.60-1.15, P = 0.25, I² = 0%).

Conclusions: Genotype-guided antiplatelet treatment could reduce the risk of HTPR, MI and ST compared with standard therapy in patients with ACS or undergoing PCI, and no significant difference was found between two groups in the major bleeding events.