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dc.contributor.authorCavallari, L.H.
dc.contributor.authorLee, C.R.
dc.contributor.authorBeitelshees, A.L.
dc.date.accessioned2019-06-21T18:46:34Z
dc.date.available2019-06-21T18:46:34Z
dc.date.issued2018
dc.identifier.urihttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85032917144&doi=10.1016%2fj.jcin.2017.07.022&partnerID=40&md5=610776702753abae2a15e088bc42effe
dc.identifier.urihttp://hdl.handle.net/10713/9788
dc.description.abstractObjectives This multicenter pragmatic investigation assessed outcomes following clinical implementation of CYP2C19 genotype-guided antiplatelet therapy after percutaneous coronary intervention (PCI). Background CYP2C19 loss-of-function alleles impair clopidogrel effectiveness after PCI. Methods After clinical genotyping, each institution recommended alternative antiplatelet therapy (prasugrel, ticagrelor) in PCI patients with a loss-of-function allele. Major adverse cardiovascular events (defined as myocardial infarction, stroke, or death) within 12 months of PCI were compared between patients with a loss-of-function allele prescribed clopidogrel versus alternative therapy. Risk was also compared between patients without a loss-of-function allele and loss-of-function allele carriers prescribed alternative therapy. Cox regression was performed, adjusting for group differences with inverse probability of treatment weights. Results Among 1,815 patients, 572 (31.5%) had a loss-of-function allele. The risk for major adverse cardiovascular events was significantly higher in patients with a loss-of-function allele prescribed clopidogrel versus alternative therapy (23.4 vs. 8.7 per 100 patient-years; adjusted hazard ratio: 2.26; 95% confidence interval: 1.18 to 4.32; p = 0.013). Similar results were observed among 1,210 patients with acute coronary syndromes at the time of PCI (adjusted hazard ratio: 2.87; 95% confidence interval: 1.35 to 6.09; p = 0.013). There was no difference in major adverse cardiovascular events between patients without a loss-of-function allele and loss-of-function allele carriers prescribed alternative therapy (adjusted hazard ratio: 1.14; 95% confidence interval: 0.69 to 1.88; p = 0.60). Conclusions These data from real-world observations demonstrate a higher risk for cardiovascular events in patients with a CYP2C19 loss-of-function allele if clopidogrel versus alternative therapy is prescribed. A future randomized study of genotype-guided antiplatelet therapy may be of value. Copyright 2018 American College of Cardiology Foundationen_US
dc.description.urihttps://dx.doi.org/10.1016/j.jcin.2017.07.022en_US
dc.language.isoen-USen_US
dc.publisherElsevier Inc.en_US
dc.relation.ispartofJACC: Cardiovascular Interventions
dc.subjectantiplatelet therapyen_US
dc.subjectcardiovascular eventsen_US
dc.subjectclopidogrelen_US
dc.subjectCYP2C19en_US
dc.subjectpercutaneous coronary interventionen_US
dc.subjectpharmacogenomicsen_US
dc.titleMultisite Investigation of Outcomes With Implementation of CYP2C19 Genotype-Guided Antiplatelet Therapy After Percutaneous Coronary Interventionen_US
dc.typeArticleen_US
dc.identifier.doi10.1016/j.jcin.2017.07.022
dc.identifier.pmid29102571


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