title: Implementation and evaluation of a CYP2C19 genotype-guided antiplatelet therapy algorithm in high-risk coronary artery disease patients.
abstract: OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  These findings suggest that using CYP2C19 genotype to guide P2Y12 inhibitor selection is feasible. Original submitted 27 October 2014; revision submitted 19 December 2014.
authors.affiliation: Division of Pharmacotherapy & Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
authors.forename: John Andrew
authors.initials: JA
authors.lastname: Lee
authors.forename: Craig R
authors.initials: CR
authors.lastname: Lee
authors.forename: Brent N
authors.initials: BN
authors.lastname: Reed
authors.forename: David C
authors.initials: DC
authors.lastname: Plitt
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Polasek
authors.forename: Lucius A
authors.initials: LA
authors.lastname: Howell
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Cicci
authors.forename: Kristen E
authors.initials: KE
authors.lastname: Tasca
authors.forename: Karen E
authors.initials: KE
authors.lastname: Weck
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Rossi
authors.forename: George A
authors.initials: GA
authors.lastname: Stouffer
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000235:genetics* / Q000473:pathology; D065731:Cytochrome P-450 CYP2C19 / Q000235:genetics*; D005260:Female; D005838:Genotype; D006801:Humans; D008658:Inactivation, Metabolic / Q000235:genetics; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D058925:Receptors, Purinergic P2Y12 / Q000235:genetics
chemical_list: C548576:P2RY12 protein, human; D010975:Platelet Aggregation Inhibitors; D058925:Receptors, Purinergic P2Y12; D065731:Cytochrome P-450 CYP2C19
keywords: clopidogrel; pharmacogenomics; prasugrel; stent; ticagrelor