{"id":"8609b28ecd28","type":"article","url":"https://hartvaat.nl/2019/10/24/genotype-geleide-p2y12-remmerkeuze-bij-primaire-pci-nejm-popular-genetics/","title":"Genotype-geleide P2Y12-remmerkeuze bij primaire PCI: NEJM POPular Genetics","title_en":"A Genotype-Guided Strategy for Oral P2Y12 Inhibitors in Primary PCI.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1907096","source_url":"https://doi.org/10.1056/NEJMoa1907096","authors":["Daniel M F Claassens","Gerrit J A Vos","Thomas O Bergmeijer","Renicus S Hermanides","Arnoud W J van 't Hof","Pim van der Harst","Emanuele Barbato","Carmine Morisco","Richard M Tjon Joe Gin","Folkert W Asselbergs","Arend Mosterd","Jean-Paul R Herrman","Willem J M Dewilde","Paul W A Janssen","Johannes C Kelder","Maarten J Postma","Anthonius de Boer","Cornelis Boersma","Vera H M Deneer","Jurriën M Ten Berg"],"significance":9,"published":"2019-10-24","source_date":"2019-10-24","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"The POPular Genetics trial showed that genotype-guided de-escalation from ticagrelor or prasugrel to clopidogrel in CYP2C19 noncarriers after primary PCI was noninferior for thrombotic events and reduced bleeding. The study established pharmacogenomic-guided antiplatelet selection as a viable personalized medicine approach.","created":"2026-07-03T10:28:13Z","updated":"2026-07-03T13:27:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM POPular Genetics-trial die genotype-geleide de-escalatie van P2Y12-remming onderzocht bij primaire PCI. Pionierswerk in farmacogenetisch gestuurd antiplaatjesbeleid.","abstract_original":"BACKGROUND: It is unknown whether patients undergoing primary percutaneous coronary intervention (PCI) benefit from genotype-guided selection of oral P2Y12 inhibitors. METHODS: We conducted a randomized, open-label, assessor-blinded trial in which patients undergoing primary PCI with stent implantation were assigned in a 1:1 ratio to receive either a P2Y12 inhibitor on the basis of early CYP2C19 genetic testing (genotype-guided group) or standard treatment with either ticagrelor or prasugrel (standard-treatment group) for 12 months. In the genotype-guided group, carriers of CYP2C19*2 or CYP2C19*3 loss-of-function alleles received ticagrelor or prasugrel, and noncarriers received clopidogrel. The two primary outcomes were net adverse clinical events - defined as death from any cause, myocardial infarction, definite stent thrombosis, stroke, or major bleeding defined according to Platelet Inhibition and Patient Outcomes (PLATO) criteria - at 12 months (primary combined outcome; tested for noninferiority, with a noninferiority margin of 2 percentage points for the absolute difference) and PLATO major or minor bleeding at 12 months (primary bleeding outcome). RESULTS: For the primary analysis, 2488 patients were included: 1242 in the genotype-guided group and 1246 in the standard-treatment group. The primary combined outcome occurred in 63 patients (5.1%) in the genotype-guided group and in 73 patients (5.9%) in the standard-treatment group (absolute difference, -0.7 percentage points; 95% confidence interval [CI], -2.0 to 0.7; P<0.001 for noninferiority). The primary bleeding outcome occurred in 122 patients (9.8%) in the genotype-guided group and in 156 patients (12.5%) in the standard-treatment group (hazard ratio, 0.78; 95% CI, 0.61 to 0.98; P = 0.04). CONCLUSIONS: In patients undergoing primary PCI, a CYP2C19 genotype-guided strategy for selection of oral P2Y12 inhibitor therapy was noninferior to standard treatment with ticagrelor or prasugrel at 12 months with respect to thrombotic events and resulted in a lower incidence of bleeding. (Funded by the Netherlands Organization for Health Research and Development; POPular Genetics ClinicalTrials.gov number, NCT01761786; Netherlands Trial Register number, NL2872.)."}