AUTHOR=Yao Haoyi , Qin Kaijie , Liu Yun , Yang Yi , Zhu Jiaxi , Chen Anqing , Wang Zhe , Ye Xiaofeng , Zhou Mi , Li Haiqing , Qiu Jiapei , Zhao Qiang , Zhu Yunpeng 

TITLE=CYP2C19 genotype and platelet aggregation test-guided dual antiplatelet therapy after off-pump coronary artery bypass grafting: A retrospective cohort study

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.1023004

DOI=10.3389/fcvm.2022.1023004

ISSN=2297-055X

ABSTRACT=<sec><title>Background</title><p>Dual antiplatelet therapy (DAPT) is recommended in patients undergoing off-pump coronary artery bypass graft surgery (OPCAB). Clopidogrel is less effective among patients with loss-of-function (LoF) of <italic>CYP2C19</italic> alleles, while ticagrelor has direct effects on P2Y<sub>12</sub> receptor. Whether a <italic>CYP2C19</italic> genotype plus platelet aggregation test (PAgT)-guided DAPT after CABG could improve clinical outcomes remain uncertain.</p></sec><sec><title>Materials and methods</title><p>From August 2019 to December 2020, 1,134 consecutive patients who underwent OPCAB received DAPT for 1 year after surgery in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. According to the actual treatment they received in real-world, 382 (33.7%) of them received a traditional DAPT: aspirin 100 mg qd + clopidogrel 75 mg qd, no matter the <italic>CYP2C19</italic> genotype and response in platelet aggregation test (PAgT). The other 752 (66.3%) patients received an individual DAPT based on <italic>CYP2C19</italic> genotype and PAgT: aspirin 100 mg qd + clopidogrel 75 mg qd if <italic>CYP2C19</italic> was extensive metabolizer, or moderate metabolizer but normal response in PAgT; aspirin 100 mg qd + ticagrelor 90 mg bid if <italic>CYP2C19</italic> was poor metabolizer, or moderate metabolizer but no or low response in PAgT. One-year follow-up was achieved for all patients. The primary outcome was major adverse cardiovascular events (MACE), a composite of cardiovascular death, myocardial infarction, and stroke. The safety outcome was thrombolysis in myocardial infarction (TIMI) criteria major bleeding.</p></sec><sec><title>Results</title><p>Compared with the traditional DAPT group, the risk of MACE in the individual DAPT group was significantly lower (5.5 vs. 9.2%, HR 0.583; 95% CI, 0.371–0.915; <italic>P</italic> = 0.019), mainly due to the decreased risk of MI (1.7 vs. 4.2%, HR 0.407; 95% CI, 0.196–0.846; <italic>P</italic> = 0.016). The risk of TIMI major bleeding events was similar between the two groups (5.3 vs. 6.0%, RR 0.883; 95% CI, 0.537–1.453; <italic>P</italic> = 0.626).</p></sec><sec><title>Conclusion</title><p>For patients who underwent OPCAB, individual DAPT (<italic>CYP2C19</italic> genotype plus PAgT-guided strategy) was associated with a lower risk of MACE and a similar risk of major bleeding.</p></sec>