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Personalized antiplatelet therapy in patients with coronary artery disease undergoing percutaneous coronary intervention: A network meta-analysis of randomized clinical trials
- Source :
- Catheterization and cardiovascular interventions : official journal of the Society for Cardiac AngiographyInterventions. 94(2)
- Publication Year :
- 2018
-
Abstract
- Objectives This study aimed to evaluate the efficacy and safety of genotype- and phenotype-guided intensified antiplatelet therapy compared with conventional therapy in patients undergoing stent implantation. Background Although potent P2Y12 receptor inhibitors are recommended for percutaneous coronary intervention (PCI)-treated acute coronary syndrome, their usage is limited by a high bleeding risk. Therefore, personalized antiplatelet therapy could provide a valuable foundation for selection of antiplatelet therapy in this population. Methods We conducted a Bayesian network meta-analysis for all randomized clinical trials (RCTs) that evaluated genotype- and/or phenotype-guided therapy in PCI-treated coronary artery disease. Results Thirteen RCTs were included with a total of 6,845 patients. The results showed no significant differences in major adverse cardiovascular events (MACE) between the treatment options ((genotype guided vs. standard of care; OR 0.64; 95% CI: 0.38-1.05) and (phenotype vs. standard of care; OR 0.93; 95% CI: 0.54-1.37)). In addition, no significant differences were demonstrated in bleeding events ((genotype guided vs. standard of care; OR 0.73; 95% CI: 0.45-1.25) and (phenotype vs. standard of care; OR 0.90; 95% CI: 0.62-1.39)). Conclusions In this mixed treatment meta-analysis of RCTs, neither genotype- nor phenotype-guided antiplatelet therapy in patients with PCI-treated coronary artery disease was superior to conventional therapy.
- Subjects :
- medicine.medical_specialty
Acute coronary syndrome
Pharmacogenomic Variants
medicine.medical_treatment
Population
Clinical Decision-Making
Network Meta-Analysis
Hemorrhage
Coronary Artery Disease
030204 cardiovascular system & hematology
law.invention
Coronary artery disease
03 medical and health sciences
0302 clinical medicine
Percutaneous Coronary Intervention
Randomized controlled trial
law
Risk Factors
Internal medicine
medicine
Humans
Radiology, Nuclear Medicine and imaging
030212 general & internal medicine
Precision Medicine
education
Randomized Controlled Trials as Topic
education.field_of_study
business.industry
Patient Selection
Percutaneous coronary intervention
Bayes Theorem
General Medicine
medicine.disease
Clopidogrel
Pharmacogenomic Testing
Cytochrome P-450 CYP2C19
Treatment Outcome
Cardiology and Cardiovascular Medicine
business
Mace
Pharmacogenetics
Platelet Aggregation Inhibitors
medicine.drug
Subjects
Details
- ISSN :
- 1522726X
- Volume :
- 94
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- Catheterization and cardiovascular interventions : official journal of the Society for Cardiac AngiographyInterventions
- Accession number :
- edsair.doi.dedup.....e2650332395b50ec2edb9a0843873331