Personalized Antiplatelet Therapy Based on CYP2C19 Genetic Testing in Patients Undergoing Percutaneous Coronary Intervention: Impact on Clinical Outcomes and Precision Cardiovascular Care

doi:N/A

Bangaldesh Journal of Cardivascular Medicine

2026, Volume 4, Issue 2 : 1-7

Research Article

Personalized Antiplatelet Therapy Based on CYP2C19 Genetic Testing in Patients Undergoing Percutaneous Coronary Intervention: Impact on Clinical Outcomes and Precision Cardiovascular Care

Arif Hossain

Nusrat Jahan

Mahmud Karim

Farhana Rahman

⁴

Kamal Uddin

⁵

Department of Interventional Cardiology, National Heart Institute, Dhaka, Bangladesh

Department of Cardiovascular Medicine, South Asia Cardiac Center, Dhaka, Bangladesh

Department of Molecular Genetics, Institute of Biomedical Sciences, Chattogram, Bangladesh

⁴

Department of Clinical Pharmacology, Bangladesh Medical University, Dhaka, Bangladesh

⁵

Department of Cardiovascular Research, Heart and Vascular Research Institute, Dhaka, Bangladesh

Abstract

Background

Dual antiplatelet therapy (DAPT) remains a cornerstone of treatment following percutaneous coronary intervention (PCI). However, interindividual variability in response to clopidogrel, largely influenced by CYP2C19 genetic polymorphisms, may increase the risk of ischemic events and stent thrombosis. Personalized antiplatelet therapy guided by genetic testing has emerged as a precision medicine strategy.

Objective

To evaluate the clinical effectiveness and safety of genotype-guided antiplatelet therapy compared with conventional treatment in patients undergoing PCI.

Methods

A prospective multicenter observational study was conducted among 620 PCI patients. CYP2C19 genotyping was performed before hospital discharge. Patients were categorized into genotype-guided and conventional treatment groups. Primary outcomes included major adverse cardiovascular events (MACE), stent thrombosis, myocardial infarction, stroke, and bleeding complications at 12 months.

Results

Loss-of-function (LOF) alleles were identified in 34.7% of patients. Patients with LOF alleles receiving ticagrelor or prasugrel experienced significantly lower MACE rates compared with clopidogrel-treated patients (6.8% vs. 14.9%, p=0.01). Definite stent thrombosis occurred in 1.3% versus 4.7% respectively. Major bleeding rates were comparable between groups.

Conclusion

Genotype-guided antiplatelet therapy improves clinical outcomes after PCI by reducing ischemic events and stent thrombosis without significantly increasing major bleeding. Personalized antiplatelet strategies represent an important advancement in precision cardiovascular medicine.

Keywords

CYP2C19

Clopidogrel Resistance

Precision Medicine

Percutaneous Coronary Intervention

Genetic Testing

Personalized Therapy

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