Genotype based personalized antiplatelet therapy in the setting of percutaneous coronary intervention (PCI) has been studied in clinical trials. Despite the demonstrated risk associated with CYP2C19 loss-of-function (LoF) carriage in clopidogrel-treated PCI patients, real-world implementation of genotyping for PCI has been low. The goal of the current study was to provide CYP2C19 genotype information to the interventionalist prior to the completion of the catheterization to facilitate immediate personalized antiplatelet therapy. Routine personalization of P2Y₁₂ inhibitor therapy for PCI in a community hospital cardiac catheterization laboratory by POC genotyping with the SpartanRx system was first offered in February 2017. A best practice advisory (BPA) based on the Clinical Pharmacogenetics Implementation Consortium Guideline for CYP2C19 genotype and clopidogrel therapy was placed in the electronic health record prescription medication ordering system. By December 2019, 1,052 patients had CYP2C19 genotype testing, 429 patients underwent PCI with genotype guided antiplatelet therapy, and 250 patients underwent PCI without genotype testing and received antiplatelet therapy at the discretion of the treating physician. BPA compliance was 93. 87% of LoF allele carriers were prescribed ticagrelor or prasugrel whereas 96% of non-LoF allele carriers were prescribed clopidogrel. The genotyping results were available within 1 h and made immediately available for decision making by the interventional cardiologist. POC CYP2C19 genotyping is feasible in a community hospital catheterization laboratory and is associated with high rate of best practice compliance.

Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03040622

经皮冠状动脉介入治疗 (PCI) 背景下基于基因型的个性化抗血小板治疗已在临床试验中进行了研究。尽管在接受氯吡格雷治疗的 PCI 患者中，已证明存在与CYP2C19 功能丧失( LoF ) 携带相关的风险，但 PCI 基因分型的实际实施率较低。当前研究的目标是在完成导管插入之前向介入医生提供CYP2C19基因型信息，以促进立即个性化抗血小板治疗。_{2017 年 2 月，社区医院心导管实验室首次通过 SpartanRx 系统进行 POC 基因分型，提供 PCI 的 P2Y 12}抑制剂常规个性化治疗。基于 CYP2C19 基因型和氯吡格雷临床药物遗传学实施联盟指南的最佳实践咨询 ( BPA )治疗被放置在电子健康记录处方药订购系统中。截至 2019 年 12 月，1,052 名患者接受了CYP2C19基因型检测，429 名患者接受了 PCI 并接受基因型引导的抗血小板治疗，250 名患者接受了 PCI 且未进行基因型检测，并根据治疗医生的判断接受了抗血小板治疗。BPA 依从性为 93。87% 的LoF等位基因携带者服用替格瑞洛或普拉格雷，而 96% 的非LoF等位基因携带者服用氯吡格雷。基因分型结果可在 1 小时内获得，并立即供介入心脏病专家做出决策。POC CYP2C19基因分型在社区医院导管实验室是可行的，并且与最佳实践的高依从率相关。

临床试验注册：https://clinicaltrials.gov/ct2/show/NCT03040622