Optimizing P2Y12 Inhibitor Therapy in Post-PCI Patients Through Genotype-Guided Strategies: A Systematic Review and Meta-Analysis.

CYP2C19 variants → reduced clopidogrel metabolism → preemptive genotyping for escalation to prasugrel/ticagrelor in poor metabolizers

This meta-analysis of 10 trials compares genotype-guided versus conventional P2Y12 inhibitor prescribing in post-PCI patients. Genotype-guided strategy significantly reduces major cardiovascular events in CYP2C19 loss-of-function variant carriers, without increasing bleeding risk. These results consolidate CPIC level A recommendations for CYP2C19 genotyping before clopidogrel.

Synthesis written by Geno'X. For the full original abstract, please refer to the source publication.

CYP2C19/clopidogrel is the archetype of actionable clinical PGx. This meta-analysis of 10 trials is a welcome update further strengthening evidence for preemptive genotyping in interventional cardiology — one of the few settings where PGx is already integrated in some hospital protocols.

Clinical impact: 2/3 · Evidence strength: 2/3 · Novelty: 1/2 · Sample size: 1/1 · Publication status: 0/1 → Total: 6/10