Impact of Genotype-Guided Versus Standard Dual Antiplatelet Therapy on Quality of Life in Acute Coronary Syndrome: A Patient-Reported Outcomes Comparison

Abstract

Background: Genotype-guided CYP2C19 dual antiplatelet therapy (DAPT) aims to enhance the balance between ischemic and bleeding events by switching ticagrelor or prasugrel to clopidogrel. Even though effective in minimizing adverse effects, the impact of genotype- guided therapy on patient-reported quality of life (QoL) remains unclear. Objective: To evaluate the impact of genotype-guided DAPT on health-related QoL in ACS patients compared to standard care. Methods: This retrospective cohort study used data from the FORCE-ACS registry and included ACS patients at St. Antonius Hospital from 2015 to 2024. Of 7166 screened patients, 972 in standard care and 314 in the genotype-guided group completed the SF-12 survey at 1 month and 1 year after initial admission. The survey assessed physical (PCS) and mental (MCS) component scores. Outcomes were compared using linear regression and multiple imputation for missing data. Results: PCS unadjusted for confounders was higher in the genotype-guided group at 1 month (47.22 vs. 45.69, p = 0.001) and 1 year (48.55 vs. 47.58, p = 0.028). MCS did not differ significantly between groups. After adjusting for potential confounders, no significant differences in PCS nor MCS were observed at either time point. Genotype-guided patients received clopidogrel more often (60.1% vs. 15.0%, p < 0.001) and experienced fewer bleeding events (66.9% vs. 72.8%, p = 0.050). Conclusion: While the genotype-guided therapy was expected to improve QoL through reduced recurrent (bleeding) events, no significant differences were observed between the cohorts. Still, the lower bleeding rates highlight the need for further research into patient- reported QoL.