Does a CYP2C19 genotype-guided algorithm influence P2Y12 inhibitor selection in high-risk CAD patients undergoing PCI?
Implementation of a CYP2C19 genotype-guided algorithm is feasible and significantly influences the selection and modification of P2Y12 inhibitor therapy in high-risk PCI patients.
AIM: An algorithm that uses clinical factors and CYP2C19 genotype to guide P2Y12 inhibitor selection in high-risk patients undergoing percutaneous coronary intervention was implemented at our institution. We sought to evaluate use of this algorithm and identify which factors influenced P2Y12 inhibitor selection. PATIENTS of these, 30% were intermediate or poor metabolizers. CYP2C19 intermediate or poor metabolizer phenotype was among the strongest predictors for selecting prasugrel or ticagrelor as maintenance therapy (p < 0.001), and was the only significant predictor of a change in therapy (p < 0.001). CONCLUSION: These findings suggest that using CYP2C19 genotype to guide P2Y12 inhibitor selection is feasible. Original submitted 27 October 2014; revision submitted 19 December 2014.
Lee et al. (Sun,) studied this question.