Myocardial Infarction Clinical Trial
Official title:
Cost-effectiveness of CYP2C19 Genotype Guided Treatment With Antiplatelet Drugs in Patients With ST-segment-elevation Myocardial Infarction Undergoing Immediate PCI With Stent Implantation: Optimization of Treatment (POPular Genetics).
Rationale: the use of antiplatelet drugs (i.e. clopidogrel, ticagrelor or prasugrel) is
crucial in the treatment of patients undergoing percutaneous coronary intervention (PCI) with
stent implantation to prevent atherothrombotic events. Ticagrelor and prasugrel are more
effective in preventing atherothrombotic events, but with a higher risk of bleeding
complications, compared to clopidogrel. Clopidogrel is converted into its active metabolite
by CYP2C19. Carriers of the non functional CYP2C19*2 and *3 alleles have an impaired CYP2C19
capacity, making clopidogrel less effective. For these subjects ticagrelor or prasugrel is an
alternative.
Objective: to assess the efficacy, safety and cost-effectiveness of the CYP2C19 genotype
guided antiplatelet treatment strategy, using clopidogrel in non-carriers of a CYP2C19*2 or
*3 allele and ticagrelor or prasugrel in carriers of a CYP2C19*2 or *3 allele in STEMI
patients.
Intervention: the intervention group will be genotyped for CYP2C19*2 and *3 allele variants
within 48 hours after primary PCI. Carriers will receive either ticagrelor (90 mg twice
daily) or prasugrel (10 mg once daily or 5 mg once daily if the patient is older than age 75
or has a body weight less than 60 kg), according to local standards. Non-carriers will be
treated with clopidogrel (75 mg once daily). The control group receives either ticagrelor or
prasugrel, according to local standards at the same dosage as the CYP2C19*2 or *3 carriers in
the intervention group. The antiplatelet drug will be continued for one year after PCI. The
follow-up duration will be one year using follow-up questionnaires.
n/a
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