Analysis Of Pharmacogenetic CYP2C19 Inpatient Testing for Acute Coronary Syndrome

Authors

• Long To, Henry Ford HealthFollow
• Benjamin A. August, Henry Ford HealthFollow
• Christine Failla, Henry Ford HealthFollow
• Tom Mikkelsen, Henry Ford HealthFollow
• Hameed Khan, Henry Ford HealthFollow
• Jennifer Frey, Henry Ford HealthFollow
• Julie Conley, Henry Ford HealthFollow
• Olena Kis, Henry Ford HealthFollow
• Lisa J. Whiteley, Henry Ford HealthFollow
• Dhananjay A. Chitale, Henry Ford HealthFollow
• Gerald Knowles, Henry Ford HealthFollow
• J. Chaben, Henry Ford Health
• Jona Lekura, Henry Ford HealthFollow
• David E. Lanfear, Henry Ford HealthFollow

Recommended Citation

To L, August BA, Failla C, Mikkelsen T, Khan H, Frey J, Conley J, Kis O, Whiteley LJ, Chitale DA, Knowles G, Chaben J, Lekura J, Lanfear DE. Analysis Of Pharmacogenetic CYP2C19 Inpatient Testing for Acute Coronary Syndrome. Clinical Pharmacology and Therapeutics 2025; 118(S1):S24.

Document Type

Conference Proceeding

Publication Date

8-26-2025

Publication Title

Clinical Pharmacology and Therapeutics

Keywords

clopidogrel, cytochrome P450 2C19, prasugrel, prostacyclin, ticagrelor, acute coronary syndrome, adult, aged, cohort analysis, conference abstract, cost control, drug cost, drug eluting stent, female, hospital discharge, hospitalization, human, major clinical study, male, non ST segment elevation myocardial infarction, outpatient, pharmacogenomics, phenotype, retrospective study, ST segment elevation myocardial infarction, therapy, unstable angina pectoris

Abstract

BACKGROUND: Pharmacogenetic (PGx) testing of CYP2C19 for clopidogrel metabolism is widely supported by clinical evidence, but few studies compare inpatient versus outpatient testing. We evaluated differences in test completion, time to intervention, and cost savings in patients admitted with acute coronary syndrome (ACS) who completed testing during hospitalization compared to those tested after discharge.

METHODS: This IRB-approved, single-centered, retrospective cohort study aimed to optimize P2Y12 inhibitor (P2Y12i) selection in patients hospitalized for ACS. Inclusion criteria: ACS diagnosis, drug eluting stent placement, discharge with a P2Y12i, and completed PGx CYP2C19 testing. The primary endpoint was time to completion of intervention, defined as days from hospital discharge to completion of therapy change. Secondary endpoints included phenotype distribution, percent of therapy change, and drug cost savings.

RESULTS: Among 181 patients who agreed to test, 87.3% (158/181) completed testing: 98% (98/100) inpatient vs. 74.1% (60/81) outpatient. Mean age was 65 ± 11 years; 60.8% were male. ACS diagnoses included STEMI (44.3%), NSTEMI (42.4%), and unstable angina (13.3%). Phenotype distribution: poor metabolizer (5.1%), intermediate (32.3%), normal (29.1%), rapid (27.2%), ultrarapid (6.3%). At discharge, 51.3% were prescribed ticagrelor, 48.1% clopidogrel, and 0.6% prasugrel. Mean time to test result for inpatient was 14.1 ± 5.5 days vs 61.6 ± 29.4 days outpatient (P < 0.001). Mean time to completion of intervention for inpatient was 25 ± 9.5 days vs. 85 ± 29.9 days outpatient (P < 0.001). Therapy changes occurred in 49 (31%) of patients: 26 patients were de-escalated from ticagrelor to clopidogrel, 21 patients had escalation of therapy based on poor and intermediate metabolizer status. Estimated drug cost savings from de-escalation of therapy was $100,620 ($55,341 inpatient n = 13; $45,279 outpatient n = 13).

CONCLUSION: Inpatient PGx CYP2C19 testing resulted in higher completion rates and faster therapy optimization. De-escalation of P2Y12i led to significant drug cost savings overall for patients and payers.

Volume

118

Issue

S1

First Page

S24