Impact of CYP2C19 point-of-care testing on the clinical outcome in patients receiving personalized clopidogrel therapy: systemic review and meta-analysis.

Summary

Across four RCTs (n=5,912), CYP2C19 point-of-care genotyping to personalize P2Y12 inhibitor selection reduced recurrent myocardial infarction and composite MACE after PCI versus standard care, without increasing bleeding. Cardiovascular death, stroke, and stent thrombosis were similar between strategies.

Key Findings

• Genotype-guided therapy reduced recurrent myocardial infarction (RR 0.54, 95% CI 0.38–0.77).
• Composite major adverse cardiovascular events were lower with genotype guidance (RR 0.59, 95% CI 0.48–0.72).
• No significant differences were observed for cardiovascular death, stroke, stent thrombosis, or bleeding.

Clinical Implications

In ACS/CAD patients undergoing PCI, implementing CYP2C19 point-of-care genotyping to guide clopidogrel versus alternative P2Y12 inhibitors may reduce MI and MACE without excess bleeding, supporting genotype-guided pathways in catheterization labs and EDs.

Limitations

• Follow-up durations and specific P2Y12 regimens across trials are not detailed in the abstract.
• Generalizability may vary by healthcare setting and availability of point-of-care genotyping.

Future Directions

Head-to-head implementation trials comparing genotype-guided pathways versus universal potent P2Y12 inhibitor strategies, cost-effectiveness analyses, and integration with platelet function testing and polygenic risk may refine precision antiplatelet care.