Title of Research: A real-world investigation of the ABCD-GENE Score on cardiovascular outcomes.
Additional Authors: A. Beitelshees; F. Franchi; M. Shahin; L. Kovar; Y. Gong; C. McDonough; J. Johnson; D. Angiolillo; L. Cavallari
Abstract:
The ABCD-GENE Score was developed to predict risk for ischemic events after percutaneous coronary intervention (PCI) and utilizes Age, Body mass index, Chronic kidney disease, Diabetes and CYP2C19 Genotype. We tested the ability of ABCD-GENE Score to predict major adverse cardiovascular events (MACE) in a real-world setting of PCI patients who received CYP2C19-guided antiplatelet therapy (APT) and compared this to prediction with CYP2C19 alone.
CYP2C19 testing to assist with APT prescribing was conducted at 3 institutions. MACE (death, myocardial infarction, stroke, stent thrombosis, or hospitalization for unstable angina) within 12 months post-PCI was ascertained through electronic health record review for clopidogrel-treated patients with acute coronary syndrome (ACS) and PCI. Multivariable Cox regression analysis was used to assess the risk of MACE according to ABCD-GENE Score using the established cutoff of 10. Survival model performance was characterized using AIC and compared between the ABCD-GENE Score and CYP2C19 alone.
A total of 821 patients (mean age 63±12, 36% female, 19% Black) were included. The risk of MACE was higher in patients with an ABCD-GENE Score ≥10 (n=194) versus <10 (n=627; 47.3 versus 23.2 per 100 patient-years, adjusted hazard ratio, 1.72; 95% CI, 1.13-2.63; p=0.011). The ABCD-GENE Score survival model outperformed CYP2C19 alone (AIC: 1274 versus 1282; p<0.001).
In clopidogrel-treated patients with ACS undergoing PCI, an ABCD-GENE Score ≥10 is associated with an increased risk for MACE and has greater accuracy than genotyping alone, thus potentially enhancing the utility of CYP2C19-guided APT. Treatment with an alternative P2Y12 inhibitor may be preferred in place of clopidogrel among patients with a high ABCD-GENE score.
About the author
Cameron D. Thomas, PharmD, is a Postdoctoral Fellow in Genomic Medicine at the University of Florida College of Pharmacy. Before enrolling in the T32 fellowship, he completed a Pharmacy Residency in Clinical Pharmacogenetics at St. Jude Children’s Research Hospital. He earned his PharmD degree from the University of Florida and completed a clinical pharmacy residency at UF Health Jacksonville. His research efforts focus on improving patient outcomes through implementing pharmacogenomics into clinical practice. Dr. Thomas is actively involved in cardiovascular and pain pharmacogenomics and has published original research papers in these areas.