Safety and Efficacy of CYP2C19 Genotype-Guided P2Y12 Receptor Inhibitor Selection Versus Conventional Antiplatelet Therapy After Complex Percutaneous Coronary Intervention: The PRECISE-PCI Randomized Clinical Trial
In Ease Asia clinical trials, P2Y12 inhibitor (ticagrelor or clopidogrel) monotherapy after 3-month dual antiplatelet therapy (DAPT) resulted in a lower incidence of clinically significant bleeding, without increasing risk of major adverse cardiac and cerebrovascular events, even if acute coronary syndrome (ACS) following complex percutaneous coronary intervention (PCI) when compared with standard DAPT. Although better understood East Asian Paradox, finding the right CYP2C19 genotype-guided P2Y12 inhibitor selection to balance maintaining ischaemic prevention and less bleeding remains a topic in real-world clinical practice.
• 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.