CYP2C19 pharmacogenetics in patients undergoing coronary stent placement: Is it time to test everyone?

Although there are no current guidelines for when to test patients for CYP2C19 loss of function alleles, the current state of evidence suggests that testing high-risk patients should be considered. Based on this meta-analysis, there is no reduction in major adverse cardiovascular events (MACE) in patients that receive genotype-guided antiplatelet therapy, but there is a significant reduction in MACE when including only patients who present with acute coronary syndromes and a significant reduction in myocardial infarction. Genotype-guided therapy shows promise but requires further study to solidify this approach, and to determine which patients derive the most benefit.