Table 1.
Ischemic cardiovascular and bleeding event risk by CYP2C19 status and P2Y12 inhibitor maintenance therapy in patients initiated on clopidogrel during the index PCI (n=601).
| Clinical outcome by CYP2C19 phenotype–selected P2Y12 inhibitor | Event No. (%)* | Event rate (per 100 pt-yrs)† | Log-rank P‡ (unadjusted) | Log-rank P‡ (adjusted) | Adjusted HR (95% CI) | P-value |
|---|---|---|---|---|---|---|
| MACCE or clinically significant bleeding events | ||||||
| Continue Clopidogrel (IM/PM) | 24 (27.6%) | 51.8 | 2.89 (1.44–6.13) | 0.003 | ||
| Continue Clopidogrel (UM/RM/NM) | 74 (17.5%) | 26.6 | 1.37 (0.76–2.70) | 0.304 | ||
| Escalation to Prasugrel/Ticagrelor (IM/PM) | 12 (13.3%) | 19.4 | P=0.007 | P=0.003 | Reference | |
| MACCE | ||||||
| Continue Clopidogrel (IM/PM)** | 23 (26.4%) | 49.5 | 5.72 (2.41–15.8) | <0.001 | ||
| Continue Clopidogrel (UM/RM/NM) | 59 (13.9%) | 20.9 | 2.27 (1.04–5.96) | 0.038 | ||
| Escalation to Prasugrel/Ticagrelor (IM/PM) | 6 (6.7%) | 9.5 | P<0.001 | P<0.001 | Reference | |
| Clinically significant bleeding events | ||||||
| Continue Clopidogrel (IM/PM)** | 2 (2.3%) | 4.3 | 0.46 (0.07–2.07) | 0.329 | ||
| Continue Clopidogrel (UM/RM/NM) | 20 (4.7%) | 7.2 | 0.64 (0.26–1.81) | 0.378 | ||
| Escalation to Prasugrel/Ticagrelor (IM/PM) | 6 (6.7%) | 9.7 | P=0.587 | P=0.559 | Reference |
Data are presented as the number (%) of patients in each group that experienced the event over 12 months of follow-up after the index PCI.
The event rate was calculated as the number of events per 100 patient-years of follow-up.
Unadjusted and covariate adjusted log-rank P-values across the three CYP2C19-antiplatelet strata. The small subset of 11 patients with a CYP2C19 UM/RM/NM phenotype that were escalated to alternative (prasugrel or ticagrelor) therapy were not included in the analysis.
Due to the rare use of clopidogrel in CYP2C19 PMs, 22 of the 23 MACCE events and both bleeding events in this group occurred in IMs.