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Point-of-Care Genetic Testing Feasible After PCI

CYP2C19*2 carriers ID'd; prasugrel therapy reduces high on-treatment platelet reactivity

THURSDAY, March 29 (HealthDay News) -- For patients who undergo percutaneous coronary intervention (PCI), point-of-care genetic testing is feasible and identifies carriers of a CYP2C19*2 allele with high sensitivity and specificity, according to a proof-of-concept study published online March 29 in The Lancet.

Jason D. Roberts, M.D., from the University of Ottawa Heart Institute in Canada, and colleagues enrolled 200 patients undergoing PCI for acute coronary syndrome or stable angina to rapid point-of-care genotyping or standard treatment. Those in the rapid genotyping group were screened for the CYP2C19*2 allele and were given 10 mg prasugrel daily (carriers) or 75 mg clopidogrel daily (noncarriers). Those in the standard treatment group received 75 mg clopidogrel daily.

After randomization, the researchers found that 187 patients completed follow-up. In each group, 23 individuals carried at least one CYP2C19*2 allele. In the rapid genotyping group, none of the carriers had high on-treatment platelet reactivity after one week of dual antiplatelet treatment, whereas seven of the carriers in the standard treatment group did (P = 0.0092). The sensitivity and specificity of the point-of-care genetic test were 100 and 99.3 percent, respectively.

"Point-of-care genetic testing after PCI can be done effectively at the bedside and treatment of identified CYP2C19*2 carriers with prasugrel can reduce high on-treatment platelet reactivity," the authors write.

One of the authors disclosed financial ties to the pharmaceutical industry and Spartan Biosciences, which funded the RAPID GENE study and developed the point-of-care genetic test used in the study.

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