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Clinical Trial
. 2018 Apr 11;16(1):92.
doi: 10.1186/s12967-018-1469-8.

Clinical implementation of rapid CYP2C19 genotyping to guide antiplatelet therapy after percutaneous coronary intervention

Larisa H Cavallari  1   2   3 , Francesco Franchi  4 , Fabiana Rollini  4 , Latonya Been  4 , Andrea Rivas  4 , Malhar Agarwal  4 , D Max Smith  5   6 , Kimberly Newsom  7 , Yan Gong  5   6 , Amanda R Elsey  5   8 , Petr Starostik  7   9 , Julie A Johnson  5   6   8 , Dominick J Angiolillo  4
Affiliations
Clinical Trial

Clinical implementation of rapid CYP2C19 genotyping to guide antiplatelet therapy after percutaneous coronary intervention

Larisa H Cavallari et al. J Transl Med. .

Abstract

Background: The CYP2C19 nonfunctional genotype reduces clopidogrel effectiveness after percutaneous coronary intervention (PCI). Following clinical implementation of CYP2C19 genotyping at University Florida (UF) Health Shands Hospital in 2012, where genotype results are available approximately 3 days after PCI, testing was expanded to UF Health Jacksonville in 2016 utilizing a rapid genotyping approach. We describe metrics with this latter implementation.

Methods: Patients at UF Health Jacksonville undergoing left heart catheterization with intent to undergo PCI were targeted for genotyping using the Spartan RX™ system. Testing metrics and provider acceptance of testing and response to genotype results were examined, as was antiplatelet therapy over the 6 months following genotyping.

Results: In the first year, 931 patients, including 392/505 (78%) total patients undergoing PCI, were genotyped. The median genotype test turnaround time was 96 min. Genotype results were available for 388 (99%) PCI patients prior to discharge. Of 336 genotyped PCI patients alive at discharge and not enrolled in an antiplatelet therapy trial, 1/6 (17%) poor metabolizers (PMs, with two nonfunctional alleles), 38/93 (41%) intermediate metabolizers (IMs, with one nonfunctional allele), and 119/237 (50%) patients without a nonfunctional allele were prescribed clopidogrel (p = 0.110). Clopidogrel use was higher among non-ACS versus ACS patients (78.6% vs. 42.2%, p < 0.001). Six months later, among patients with follow-up data, clopidogrel was prescribed in 0/4 (0%) PMs, 33/65 (51%) IMs, and 115/182 (63%) patients without a nonfunctional allele (p = 0.008 across groups; p = 0.020 for PMs versus those without a nonfunctional allele).

Conclusion: These data demonstrate that rapid genotyping is clinically feasible at a high volume cardiac catheterization facility and allows informed chronic antiplatelet prescribing, with lower clopidogrel use in PMs at 6 months. Trial registration ClinicalTrials.gov Identifier: NCT02724319; registered March 31, 2016; https://www.clinicaltrials.gov/ct2/show/NCT02724319?term=angiolillo&rank=7.

Keywords: CYP2C19; Clopidogrel; Genotype; Percutaneous coronary intervention; Prasugrel; Ticagrelor.

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Figures

Fig. 1
Fig. 1
Percent of patients on clopidogrel at discharge and 6 months by CYP2C19 phenotype. PM poor metabolizer, IM intermediate metabolizer. Other includes normal metabolizers, rapid metabolizers, and ultra-rapid metabolizers. *p = 0.020 for PM versus other at 6 months. **p = 0.104 for IM versus other at 6 months
See this image and copyright information in PMC

References

    1. Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, et al. 2015 ACC/AHA/SCAI focused update on primary percutaneous coronary intervention for patients with ST-elevation myocardial infarction: an Update of the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention and the 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American college of cardiology/American heart association task force on clinical practice guidelines and the society for cardiovascular angiography and interventions. Circulation. 2016;133:1135–1147. doi: 10.1161/CIR.0000000000000336. - DOI - PubMed
    1. Valgimigli M, Bueno H, Byrne RA, Collet JP, Costa F, Jeppsson A, Juni P, Kastrati A, Kolh P, Mauri L, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: the task force for dual antiplatelet therapy in coronary artery disease of the European society of cardiology (ESC) and of the European association for cardio-thoracic surgery (EACTS) Eur Heart J. 2017;53(1):34–78. - PubMed
    1. Rollini F, Franchi F, Angiolillo DJ. Switching P2Y12-receptor inhibitors in patients with coronary artery disease. Nat Rev Cardiol. 2016;13:11–27. doi: 10.1038/nrcardio.2015.113. - DOI - PubMed
    1. Fan W, Plent S, Prats J, Deliargyris EN. Trends in P2Y12 inhibitor use in patients referred for invasive evaluation of coronary artery disease in contemporary US practice. Am J Cardiol. 2016;117:1439–1443. doi: 10.1016/j.amjcard.2016.02.012. - DOI - PubMed
    1. Park Y, Franchi F, Rollini F, Angiolillo DJ. Dual antiplatelet therapy after coronary stenting. Expert Opin Pharmacother. 2016;17:1775–1787. doi: 10.1080/14656566.2016.1202924. - DOI - PubMed

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