Table 2.
Ischemic cardiovascular and bleeding event risk by CYP2C19 status and P2Y12 inhibitor maintenance therapy in patients initiated on prasugrel or ticagrelor during the index PCI (n=312).
| 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 | ||||||
| De-escalation to Clopidogrel (UM/RM/NM) | 10 (14.5%) | 21.3 | 1.35 (0.54–3.27) | 0.511 | ||
| Continue Prasugrel/Ticagrelor (UM/RM/NM) | 17 (13.0%) | 20.4 | 1.36 (0.63–3.00) | 0.438 | ||
| Continue Prasugrel/Ticagrelor (IM/PM) | 13 (11.6%) | 17.9 | P=0.884 | P=0.710 | Reference | |
| MACCE | ||||||
| De-escalation to Clopidogrel (UM/RM/NM) | 7 (10.1%) | 14.8 | 1.07 (0.36–3.03) | 0.895 | ||
| Continue Prasugrel/Ticagrelor (UM/RM/NM) | 14 (10.7%) | 16.2 | 1.27 (0.54–3.09) | 0.590 | ||
| Continue Prasugrel/Ticagrelor (IM/PM) | 10 (8.9%) | 13.5 | P=0.906 | P=0.854 | Reference | |
| Clinically significant bleeding events | ||||||
| De-escalation to Clopidogrel (UM/RM/NM) | 4 (5.8%) | 8.5 | 2.67 (0.53–14.9) | 0.228 | ||
| Continue Prasugrel/Ticagrelor (UM/RM/NM) | 6 (4.6%) | 7.2 | 2.41 (0.57–12.7) | 0.239 | ||
| Continue Prasugrel/Ticagrelor (IM/PM) | 3 (2.7%) | 4.1 | P=0.608 | P=0.438 | 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-value across the three CYP2C19-antiplatelet strata. The small subset of 4 patients with a CYP2C19 IM phenotype that were de-escalated to clopidogrel therapy were not included in the analysis.