Why the study?
Does a CYP2C19 genotype-guided algorithm influence P2Y12 inhibitor selection in high-risk CAD patients undergoing PCI?
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.
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Supports CYP2C19-guided P2Y12 selection post-PCI; hypothesis-generating for genotype-directed strategies, pending randomized outcome trials.
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 & METHODS: This retrospective cohort study included 264 patients receiving percutaneous coronary intervention from July-December 2012. RESULTS: CYP2C19 genotype was obtained in 229 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.
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Lee et al. (2015) studied this question.
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