Evaluating the Effect of Estimating Renal Function With the CKD‐EPI 2021 Equation on the ABCD‐GENE Score for Clopidogrel Response Prediction

Abstract

The ABCD‐GENE score was developed to predict poor response to clopidogrel and includes Age, Body mass index, Chronic kidney disease (CKD; estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m2), Diabetes, and CYP2C19 GENE variants; a score ≥ 10 is predictive of reduced clopidogrel effectiveness after percutaneous coronary intervention (PCI). Estimation of GFR without a race variable via the CKD‐EPI Scr 2021 equation is now recommended. We examined the impact of using the CKD‐EPI Scr 2021 vs. 2009 equation on the ABCD‐GENE score for post‐PCI patients. A total of 4335 adult patients (n = 925 Black) who underwent PCI and CYP2C19 genotyping were included, with GFR estimated for each patient via the CKD‐EPI Scr 2021 and CKD‐EPI 2009 equations. The ABCD‐GENE score, calculated based on each GFR estimation, was compared. With the CKD‐EPI Scr 2021 vs. 2009 equation, median (IQR) eGFR was lower (74 [55–94] vs. 81 [60–103] mL/min/1.73 m2, P < 0.001), and CKD prevalence was higher (31% vs. 25%, P < 0.001) among Black patients, whereas eGFR was higher (85 [65–99] vs. 80 [61–94] mL/min/1.73m2, P < 0.001), and CKD prevalence was lower (20% vs. 24%, P < 0.001) in non‐Black patients. This led to 12 (1%) Black patients being reclassified from low to high risk of poor clopidogrel response and 30 (1%) non‐Black patients being recategorized from high to low risk (P < 0.001 for both comparisons). Removal of the race variable from GFR estimation significantly impacted the prediction of clopidogrel effectiveness via the ABCD‐GENE score.