CYP2C19 Genotype-Guided P2Y12 Receptor Inhibitor Selection After Complex Percutaneous Coronary Intervention

Korábbi kezelés

• Planned surgery within 90 days.
• Concomitant therapy with a strong CYP3A4 inhibitor or inducer

Más betegség

• Requiring oral anticoagulation therapy (eg, atrial fibrillation, deep vein thrombosis, pulmonary thromboembolism)
• Intracranial/gastrointestinal/urogenital bleeding within 6 months.

Laborértékek

• Active bleeding or bleeding diathesis, thrombocytopenia (platelet <100,000/mL) or hemoglobin <10 g/dL
• Hepatic dysfunction (serum liver enzyme>3 times the normal limit)
• Renal failure (eGFR <15 ml/min/1.73m2 or requiring dialysis)

Egyéb

• Patient with known CYP2C19 genotype before randomization.
• Anticipated discontinuation of clopidogrel or ticagrelor within the 12-month follow-up period.
• Life expectancy < 1 year

• Clinical Criteria:
  • Patients aged between 18-80 years old.
  • Patients with ACS (UA/NSTEMI/STEMI) undergoing PCI.
  • Patients will be treated with DAPT (P2Y12 inhibitors+aspirin) for at least 3 months.
  • Patients are willing to provide a DNA sample (via blood draw) for CYP2C19 genotyping.
  • Patients provide written informed consent before enrollment.
• Angiographic Criteria (meet at least 1 of the following characteristics):
  • Thrombotic target lesion.
  • Calcified target lesion requiring rotational atherectomy or intravascular lithotripsy
  • Multivessel (≥2 vessels) disease will be treated.
  • Multi-target lesions (≥3 lesions) will be treated.
  • Multi-stent (≥3 stents) will be implanted.
  • Total stent length≥60 mm.
  • Bifurcation lesion requiring at least 2 stents.
  • PCI for left main.
  • PCI for chronic total occlusion.
  • PCI for bypass graft.