A real-world study of clopidogrel therapy in patients with acute coronary syndrome undergoing percutaneous coronary intervention guided by individualized metabolic types

Purpose: To explore the relationship between adopting the recommendation for clopidogrel use based on genotype guidance in Acute Coronary Syndrome (ACS) patients undergoing Percutaneous Coronary Intervention (PCI) and the incidence of later cardiovascular ischemic and bleeding events. Methods: A retrospective study was conducted on 3, 004 ACS patients treated with clopidogrel. Patients were grouped based on CYP2C19 genotype and followed for one year to record cardiovascular adverse and bleeding events. Results: Adopting the recommendation for clopidogrel use can reduce the risk of total ischemic events in the intermediate metabolic group (Odds Ratio [OR], 0.676; P = 0.041). In the poor metabolic group, the recommendations could reduce the risk of in-stent stenosis/thrombosis (OR, 0.150; P = 0.035), revascularization (OR, 0.252; P = 0.048), and total ischemic events (OR, 0.350; P = 0.006). Individualized guidance based on the CYP2C19 genotype did not increase bleeding outcomes. Conclusion: Individualized clopidogrel guidance based on genotype can reduce the ischemic risk in patients with intermediate and poor metabolizers, and the poor metabolic group benefits more. Individualized guidance did not increase bleeding outcomes in patients with intermediate or poor metabolizers.