Background Although platelet function and pharmacogenomic testing have been studied in clinical trials, their adoption into contemporary practice is unknown. Methods We studied patterns of platelet function and pharmacogenomic testing among 10,048 patients with acute myocardial infarction treated with percutaneous coronary intervention at 226 US hospitals in the TRANSLATE-ACS observational study between April 2010 and October 2012, excluding those receiving research protocol-mandated testing. Inverse probability-weighted propensity adjustment was used to compare 1-year bleeding and major adverse cardiac event risks between patients with and without testing. Results Overall, 337 (3.4%) patients underwent predischarge platelet function testing, whereas 85 (0.9%) underwent pharmacogenomic testing; 82% and 93% of hospitals never performed any platelet function or pharmacogenomic testing, respectively. Patients undergoing testing were more likely to be on an adenosine diphosphate receptor inhibitor preadmission or to have percutaneous coronary intervention of a previously treated lesion. Tested patients were more likely than nontested patients to be switched from clopidogrel to prasugrel/ticagrelor (25.7% vs 9.7%, P <.001) and were more likely to be on prasugrel/ticagrelor 6 months postdischarge (33.8% vs 25.1%, P <.001). No significant differences in 1-year bleeding and major adverse cardiac event risks were observed between tested and nontested patients (adjusted hazard ratios 1.06 [95% CI 0.68-1.65] and 1.21 [95% CI 0.94-1.54], respectively). Conclusions Platelet function and pharmacogenomic testing are rarely performed in contemporary myocardial infarction patients in the United States. When tested, patients were more likely to be treated with higher-potency adenosine diphosphate receptor inhibitors, yet no significant differences in longitudinal outcomes were observed.
Bibliographical noteFunding Information:
The TRANSLATE-ACS study was funded by Daiichi Sankyo, Inc, and Lilly USA. All data analyses were performed independently by statisticians at the Duke Clinical Research Institute using SAS version 9.2 (SAS Institute, Cary, NC). The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the manuscript, and its final contents.
Dr Wang reports institutional research grant support from Eli Lilly, Daiichi Sankyo, Gilead Sciences, Glaxo Smith Kline, and the American College of Cardiology, as well as honoraria from AstraZeneca and the American College of Cardiology. Dr Henry reports consulting honorarium from Eli Lilly and Daiichi Sankyo. Dr Berger reports research grant support to the institution from Janssen, The Medicines Company, Astra Zeneca, Eli Lilly, and Sanofi Aventis (all significant) and consulting for Janssen and Medicure. Dr Cohen reports research grant support from Eli Lilly, Daiichii Sankyo, and Astra Zeneca; consulting fees from Eli Lilly and Astra Zeneca; and speaking honoraria from Eli Lilly and Astra Zeneca. Dr Effron reports being an employee of Eli Lilly and Company and a shareholder of Lilly, USA. Dr Zettler reports being an employee of Eli Lilly and Company. Dr Baker reports being an employee of Daiichi Sankyo, Inc. Dr Peterson reports research funding to Duke Clinical Research Institute from the American College of Cardiology, American Heart Association, Eli Lilly & Company, and Janssen Pharmaceuticals, and consulting (including CME) for Merck & Co, Boehringer Ingelheim, Genentech, Janssen Pharmaceuticals, and Sanofi-Aventis. Ms McCoy and Dr Messenger have no relevant disclosures to report.