Genotype‐guided antiplatelet therapy for acute coronary syndrome percutaneous coronary intervention patients: A new standard of care?

2021 ◽  
Vol 97 (5) ◽  
pp. 795-796
Author(s):  
Kellan E. Ashley ◽  
William B. Hillegass
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Standard Of Care ◽  
Coronary Intervention ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

scholarly journals Personalized Antiplatelet Therapy Based on CYP2C19 Genotypes in Chinese ACS Patients Undergoing PCI: A Randomized Controlled Trial

2021 ◽  
Vol 8 ◽  
Author(s):  
Xiujin Shi ◽  
Yunnan Zhang ◽  
Yi Zhang ◽  
Ru Zhang ◽  
Baidi Lin ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Confidence Interval ◽  
Antiplatelet Therapy ◽  
Primary Endpoint ◽  
Coronary Intervention ◽  
Chinese Patients ◽  
Bleeding Events ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Background: The clinical benefits of cytochrome P450 (CYP) 2C19 genotype-guided antiplatelet therapy in Asians remain unclear. In this study, we aimed to investigate the clinical outcomes of pharmacogenomic antiplatelet therapy in Chinese patients.Methods: Patients with acute coronary syndrome planning to undergo percutaneous coronary intervention were eligible for this study and were randomly divided into a genotype-guided treatment (GT) group and routine treatment (RT) group, with a ratio of 2:1. Patients in the GT group underwent CYP2C19 genotyping (*2 and *3 alleles), and the results were considered in selecting P2Y12 receptor inhibitors. Patients in the RT group were treated with P2Y12 receptor inhibitors according to their clinical characteristics. The primary endpoint was a composite of major adverse cardiovascular or cerebrovascular events (MACCE). The secondary endpoint was significant bleeding events.Results: Finally, 301 patients were enrolled; 75.1% were men and the mean age was 59.7 ± 9.8 years. In total, 281 patients completed the follow-up procedure. The primary endpoint occurred in 16 patients, 6 patients in the GT group and 10 in the RT group. The GT group showed lower MACCE rates than the RT group (6/189 vs. 10/92, 3.2 vs. 10.9%, hazard ratio: 0.281, 95% confidence interval: 0.102–0.773, P = 0.009). There was no statistically difference in significant bleeding events between the GT and RT groups (4.2 vs. 3.3%, hazard ratio: 1.315, 95% confidence interval: 0.349–4.956, P = 0.685).Conclusion: Personalized antiplatelet therapy that is based on CYP2C19 genotypes could decrease MACCE within a 12-month period in Chinese patients with acute coronary syndrome undergoing percutaneous coronary intervention.Clinical Trial Registration:http://www.chictr.org.cn, identifier: ChiCTR2000034352.

Pharmacology of oral antiplatelet drugs

ESC CardioMed ◽  
2018 ◽  
pp. 195-200
Author(s):  
Tabassome Simon
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Cardiovascular Events ◽  
Coronary Intervention ◽  
Compelling Evidence ◽  
Coronary Syndrome ◽  
Randomized Controlled ◽  
Randomized Controlled Studies ◽  
Percutaneous Coronary

Compelling evidence from randomized controlled studies have confirmed the efficacy of dual antiplatelet therapy, with aspirin and a P2Y12 inhibitor, in reducing the risk of cardiovascular events particularly among patients with acute coronary syndrome and/or those undergoing percutaneous coronary intervention. They thus represent one of the most frequently prescribed drugs worldwide.

scholarly journals Cost analysis of dual antiplatelet therapy with prasugrel and ticagrelor in patients with acute coronary syndrome after percutaneous coronary intervention

2020 ◽  
Vol 25 (8) ◽  
pp. 4063
Author(s):  
I. N. Dyakov ◽  
E. A. Ushkalova
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Cost Analysis ◽  
Antiplatelet Therapy ◽  
Healthcare System ◽  
Coronary Intervention ◽  
Complete Replacement ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
The Cost

Aim. To conduct a cost analysis of using novel inhibitors of P2Y 12 (prasugrel and ticagrelor) in patients with acute coronary syndrome (ACS) in the Russian healthcare system.Material and methods. The analysis was performed using the design of a comparative study of prasugrel and ticagrelor ISAR-REACT 5. The loading and maintenance doses of the drugs, the percentage of patients who stopped therapy and the median duration of administration before withdrawal were taken into account. The cost of treating clinical events associated with the primary and secondary endpoints was estimated according to the data on diagnosis-related groups for 2020. The cost of hospitalization was calculated as the average of the cost of treating various diseases, taking into account the base rate for a hospital. The result was expressed as the weighted average cost per patient for 1 year (365 days). The maintenance dose used in calculations was 10 mg/day for prasugrel and 90 mg 2 times/day for ticagrelor.Results. Prasugrel is less expensive for use than ticagrelor. For 1-year therapy, the difference is 8386,31 rubles or 10,57%. The proportion of using prasugrel in 2019 was only 2,17%. With the current ratio of using ticagrelor and prasugrel, the budgetary pressures of therapy corresponding to 19,382.7 patient-years will amount to 1,534 billion rubles. An increase in the proportion of prasugrel leads to a decrease in the total expenses of managing patients with ACS after percutaneous coronary intervention who require antiplatelet therapy. With the complete replacement of ticagrelor with prasugrel, the savings will be 10,36% or 159,03 million rubles. With an increase in the proportion of prasugrel, the total expenses will decrease, and with a complete replacement of ticagrelor with prasugrel, the savings compared to using only ticagrelor will amount to 1,353.7 million rubles.Conclusion. The analysis showed that the use of prasugrel in the population is less costly in the healthcare system. However, the result obtained is relevant only with price changes for one of the drugs not exceeding 10% and not relevant with multidirectional simultaneous changes in prices for compared drugs. Increasing the proportion of prasugrel and replacing it with ticagrelor will reduce the budgetary pressures.

scholarly journals Adherence to Medical Treatment in Patients who Have Experienced Acute Coronary Syndrome and Percutaneous Coronary Intervention

Kardiologiia ◽  
2019 ◽  
Vol 59 (1) ◽  
pp. 36-38
Author(s):  
N. M. Kuzmina ◽  
N. I. Maximov
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Coronary Intervention ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
History Of ◽  
Adherence To Therapy

Purpose: to study adherence to therapy after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). We analyzed retrospectively 127 case histories of patients who underwent PCI for ACS in 2015 (in Udmurtia at that time PCIs were mostly carried out later than 6 hours after onset of symptoms). Inclusion criteria: age 25–75 years; confirmed ACS; stenting of coronary arteries for the first time. Exclusion criteria: pregnancy; prisoners; incompetent persons; history of PCI or coronary artery bypass grafting. In two years after the PCI 95 patients were questioned concerning use of statins (including their doses) and dual antiplatelet therapy (DAPT). Results. In 2 years after index PCI 83% of patients took statins regularly. DAPT for 1 year or more after PCI received 85% of patients. Conclusion. Adherence to therapy with statins and antiplatelet therapy was found to be high. PCI in patients with ACS was mainly delayed (more than 6 hours from the onset of symptoms). It is necessary to further improve the routing of patients to PCI performing centers from Udmurtia regions for the timely myocardial revascularization.

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