- Question
- Can a strategy that selects the oral P2Y12 inhibitor according to CYP2C19 genotype match the efficacy of standard ticagrelor or prasugrel treatment in patients undergoing primary PCI, with less bleeding?
- Design
- Randomized 1:1, open-label, assessor-blinded trial in patients undergoing primary PCI with stent implantation. The primary analysis included 2488 patients (1242 in the genotype-guided group and 1246 in the standard-treatment group), with 12 months of follow-up.
- Population
- Patients undergoing primary percutaneous coronary intervention with stent implantation.
- Intervention
- Genotype-guided strategy: after early CYP2C19 genetic testing, carriers of *2 or *3 loss-of-function alleles received ticagrelor or prasugrel and noncarriers received clopidogrel, for 12 months.
- Control
- Standard treatment with ticagrelor or prasugrel for 12 months, without genotype guidance.
- Primary outcome
- Two primary outcomes: net adverse clinical events (death from any cause, myocardial infarction, definite stent thrombosis, stroke, or PLATO major bleeding) at 12 months, tested for noninferiority with a 2 percentage point margin; and PLATO major or minor bleeding at 12 months.
- Results
- Net adverse clinical events occurred in 63 patients (5.1%) in the genotype-guided group and 73 (5.9%) in the standard-treatment group (absolute difference -0.7 percentage points; 95% CI, -2.0 to 0.7; P<0.001 for noninferiority). PLATO major or minor bleeding occurred in 122 patients (9.8%) versus 156 (12.5%) (HR 0.78; 95% CI, 0.61 to 0.98; P = 0.04).
- Conclusion
- A CYP2C19 genotype-guided strategy was noninferior to standard ticagrelor or prasugrel treatment for thrombotic events and was associated with a lower incidence of bleeding.
- Why it matters
- It showed that individualizing the P2Y12 inhibitor by genotype can preserve ischemic protection while reducing bleeding after primary PCI, supporting de-escalation approaches to antiplatelet therapy.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026