Guided selection of antiplatelet therapy in acute coronary syndrome: Impact on outcomes and resource utilization

Dual antiplatelet therapy, consisting of aspirin and a P2Y12 inhibitor, represents the standard of care for patients undergoing percutaneous coronary intervention (PCI) or those with acute coronary syndrome (ACS) [ [1] Capodanno D. Alfonso F. Levine G.N. Valgimigli M. Angiolillo D.J. ACC/AHA versus esc guidelines on dual antiplatelet therapy: JACC guideline comparison. J. Am. Coll. Cardiol. 2018; 72: 2915-2931 Crossref PubMed Scopus (167) Google Scholar ]. Compared with clopidogrel, prasugrel and ticagrelor are characterized by more potent, fast and predictable platelet P2Y12 inhibitory effects resulting in reduced rates of major adverse cardiovascular events but at the expense of increased bleeding [ [2] Franchi F. Angiolillo D.J. Novel antiplatelet agents in acute coronary syndrome. Nat. Rev. Cardiol. 2015; 12: 30-47 Crossref PubMed Scopus (243) Google Scholar ]. Accordingly, Guidelines recommend the use of prasugrel and ticagrelor over clopidogrel among patients with ACS, unless these are not available or contraindicated, while clopidogrel is the P2Y12 inhibitor of choice in patients with chronic coronary syndrome (CCS) [ [1] Capodanno D. Alfonso F. Levine G.N. Valgimigli M. Angiolillo D.J. ACC/AHA versus esc guidelines on dual antiplatelet therapy: JACC guideline comparison. J. Am. Coll. Cardiol. 2018; 72: 2915-2931 Crossref PubMed Scopus (167) Google Scholar , [3] Collet J.-P. Thiele H. Barbato E. Barthélémy O. Bauersachs J. Bhatt D.L. et al. 2020 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur. Heart J. 2020; 42: 1289-1367 Crossref Scopus (1017) Google Scholar , [4] Ibanez B. James S. Agewall S. Antunes M.J. Bucciarelli-Ducci C. Bueno H. et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur. Heart J. 2018; 39: 119-177 Crossref PubMed Scopus (4590) Google Scholar ]. Bedside testing of CYP2C19 vs. conventional clopidogrel treatment to guide antiplatelet therapy in ST-segment elevation myocardial infarction patientsInternational Journal of CardiologyVol. 343PreviewST-segment elevation myocardial infarction (STEMI) patients are treated with dual antiplatelet therapy comprising aspirin and a P2Y12 inhibitor. Clopidogrel is widely used in these patients in several areas worldwide, such as Middle East, but is associated to sub-optimal platelet inhibition in up to 1/3 of treated patients. We investigated a CYP2C19 genotype-guided strategy to select the optimal P2Y12 inhibitor. Full-Text PDF Open Access