TY - JOUR
T1 - Tailored P2Y12 inhibitor treatment in patients undergoing non-urgent PCI—the POPular Risk Score study
AU - Janssen, Paul W.A.
AU - Bergmeijer, Thomas O.
AU - Vos, Gert Jan A.
AU - Kelder, Johannes C.
AU - Qaderdan, Khalid
AU - Godschalk, Thea C.
AU - Breet, Nicoline J.
AU - Deneer, Vera H.M.
AU - Hackeng, Christian M.
AU - ten Berg, Jurriën M.
N1 - Funding Information:
The authors would like to thank all personnel of the St. Antonius Hospital and the referring hospitals involved in this project.
Funding Information:
Funding This study was supported by the St. Antonius Innovation fund and a ZonMw TopZorg grant. ZonMw is a Dutch organization funded by the government promoting health care research and the implementation of study results in daily practice. The authors were solely responsible for the design and conduct of this study, all study analyses, and the drafting and editing of the paper and its final contents.
Publisher Copyright:
© 2019, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2019/9/1
Y1 - 2019/9/1
N2 - PURPOSE: The POPular Risk Score was developed for the selective intensification of P2Y
12 inhibitor treatment with prasugrel instead of clopidogrel in patients undergoing non-urgent percutaneous coronary intervention (PCI) with stent implantation. This score is based on platelet reactivity (VerifyNow P2Y
12 assay), CYP2C19 genotyping, and clinical risk factors. Our aim was to determine if the use of this score in clinical practice is associated with a reduction in thrombotic events without increasing bleeding events.
METHODS: In a single-center prospective cohort study, patients with a high risk score were treated with prasugrel and patients with a low risk score with clopidogrel. The risk score-guided cohort was compared with a historic cohort of clopidogrel-treated patients. The endpoint consisted of all-cause death, myocardial infarction, stroke, or stent thrombosis during 1 year of follow-up. TIMI major and minor bleeding events were also analyzed.RESULTS: The guided cohort contained 1127 patients, 26.9% of whom were switched to prasugrel according to the POPular Risk Score. The historic cohort contained 893 patients. The incidence of the combined thrombotic endpoint was significantly lower in the guided cohort as compared with the historic cohort (8.4% versus 3.7%, p < 0.001). This strategy was safe with respect to bleeding (4.0% versus 1.3%, p < 0.001, for TIMI major or minor bleeding). Results were comparable after multivariate and propensity score matched and weighted analysis.CONCLUSION: Selective intensification of P2Y
12 inhibitor treatment after non-urgent PCI based on the POPular Risk Score is associated with a reduction in thrombotic events without an increase in bleeding events.
AB - PURPOSE: The POPular Risk Score was developed for the selective intensification of P2Y
12 inhibitor treatment with prasugrel instead of clopidogrel in patients undergoing non-urgent percutaneous coronary intervention (PCI) with stent implantation. This score is based on platelet reactivity (VerifyNow P2Y
12 assay), CYP2C19 genotyping, and clinical risk factors. Our aim was to determine if the use of this score in clinical practice is associated with a reduction in thrombotic events without increasing bleeding events.
METHODS: In a single-center prospective cohort study, patients with a high risk score were treated with prasugrel and patients with a low risk score with clopidogrel. The risk score-guided cohort was compared with a historic cohort of clopidogrel-treated patients. The endpoint consisted of all-cause death, myocardial infarction, stroke, or stent thrombosis during 1 year of follow-up. TIMI major and minor bleeding events were also analyzed.RESULTS: The guided cohort contained 1127 patients, 26.9% of whom were switched to prasugrel according to the POPular Risk Score. The historic cohort contained 893 patients. The incidence of the combined thrombotic endpoint was significantly lower in the guided cohort as compared with the historic cohort (8.4% versus 3.7%, p < 0.001). This strategy was safe with respect to bleeding (4.0% versus 1.3%, p < 0.001, for TIMI major or minor bleeding). Results were comparable after multivariate and propensity score matched and weighted analysis.CONCLUSION: Selective intensification of P2Y
12 inhibitor treatment after non-urgent PCI based on the POPular Risk Score is associated with a reduction in thrombotic events without an increase in bleeding events.
KW - Clopidogrel
KW - CYP2C19
KW - P2Y inhibitor
KW - Percutaneous coronary intervention
KW - Platelet aggregation
KW - Prasugrel
KW - Thrombosis/prevention & control
KW - Humans
KW - Middle Aged
KW - Genotype
KW - Male
KW - Risk
KW - Purinergic P2Y Receptor Antagonists/adverse effects
KW - Hemorrhage/chemically induced
KW - Stroke/prevention & control
KW - Clopidogrel/adverse effects
KW - Platelet Function Tests
KW - Prasugrel Hydrochloride/adverse effects
KW - Cytochrome P-450 CYP2C19/genetics
KW - Female
KW - Aged
KW - Myocardial Infarction/prevention & control
KW - Percutaneous Coronary Intervention
UR - http://www.scopus.com/inward/record.url?scp=85067784585&partnerID=8YFLogxK
U2 - 10.1007/s00228-019-02696-z
DO - 10.1007/s00228-019-02696-z
M3 - Article
C2 - 31197411
AN - SCOPUS:85067784585
SN - 0031-6970
VL - 75
SP - 1201
EP - 1210
JO - European Journal of Clinical Pharmacology
JF - European Journal of Clinical Pharmacology
IS - 9
ER -