title: Contemporary use of platelet function and pharmacogenomic testing among patients with acute myocardial infarction undergoing percutaneous coronary intervention in the United States.
abstract: BACKGROUND
  Although platelet function and pharmacogenomic testing have been studied in clinical trials, their adoption into contemporary practice is unknown.
  
  
  METHODS
  We studied patterns of platelet function and pharmacogenomic testing among 10,048 patients with acute myocardial infarction treated with percutaneous coronary intervention at 226 US hospitals in the TRANSLATE-ACS observational study between April 2010 and October 2012, excluding those receiving research protocol-mandated testing. Inverse probability-weighted propensity adjustment was used to compare 1-year bleeding and major adverse cardiac event risks between patients with and without testing.
  
  
  RESULTS
  Overall, 337 (3.4%) patients underwent predischarge platelet function testing, whereas 85 (0.9%) underwent pharmacogenomic testing; 82% and 93% of hospitals never performed any platelet function or pharmacogenomic testing, respectively. Patients undergoing testing were more likely to be on an adenosine diphosphate receptor inhibitor preadmission or to have percutaneous coronary intervention of a previously treated lesion. Tested patients were more likely than nontested patients to be switched from clopidogrel to prasugrel/ticagrelor (25.7% vs 9.7%, P < .001) and were more likely to be on prasugrel/ticagrelor 6 months postdischarge (33.8% vs 25.1%, P < .001). No significant differences in 1-year bleeding and major adverse cardiac event risks were observed between tested and nontested patients (adjusted hazard ratios 1.06 [95% CI 0.68-1.65] and 1.21 [95% CI 0.94-1.54], respectively).
  
  
  CONCLUSIONS
  Platelet function and pharmacogenomic testing are rarely performed in contemporary myocardial infarction patients in the United States. When tested, patients were more likely to be treated with higher-potency adenosine diphosphate receptor inhibitors, yet no significant differences in longitudinal outcomes were observed.
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC. Electronic address: tracy.wang@duke.edu.
authors.forename: Tracy Y
authors.initials: TY
authors.lastname: Wang
authors.affiliation: Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Henry
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: McCoy
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Berger
authors.affiliation: St Luke's Mid America Heart Institute, Kansas City, MO.
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
authors.affiliation: Lilly USA, LLC, Indianapolis, IN.
authors.forename: Mark B
authors.initials: MB
authors.lastname: Effron
authors.affiliation: Lilly USA, LLC, Indianapolis, IN.
authors.forename: Marjorie
authors.initials: M
authors.lastname: Zettler
authors.affiliation: Daiichi Sankyo, Inc, Parsippany, NJ.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Baker
authors.affiliation: Denver Veterans Affairs Medical Center, Denver, CO.
authors.forename: John C
authors.initials: JC
authors.lastname: Messenger
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
mesh_terms: D000368:Aged; D001792:Blood Platelets / Q000502:physiology*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D010597:Pharmacogenetics / Q000379:methods*; D015539:Platelet Activation / Q000187:drug effects*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D010979:Platelet Function Tests; D057234:Preoperative Period; D011446:Prospective Studies; D014481:United States
chemical_list: D010975:Platelet Aggregation Inhibitors