• Dirk Sibbing, Daniel Aradi, Dimitrios Alexopoulos, Jurrien Ten Berg, Deepak L Bhatt, Laurent Bonello, Jean-Philippe Collet, Thomas Cuisset, Francesco Franchi, Lisa Gross, Paul Gurbel, Young-Hoon Jeong, Roxana Mehran, David J Moliterno, Franz-Josef Neumann, Naveen L Pereira, Matthew J Price, Marc S Sabatine, So Derek Y F DYF Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada., Gregg W Stone, Robert F Storey, Udaya Tantry, Dietmar Trenk, Marco Valgimigli, Ron Waksman, and Dominick J Angiolillo.
• Department of Cardiology, LMU München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany. Electronic address: dirk.sibbing@med.uni-muenchen.de.
• JACC Cardiovasc Interv. 2019 Aug 26; 12 (16): 1521-1537.

AbstractDual-antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor is the standard treatment for patients undergoing percutaneous coronary intervention. The availability of different P2Y12 receptor inhibitors (clopidogrel, prasugrel, ticagrelor) with varying levels of potency has enabled physicians to contemplate individualized treatment regimens, which may include escalation or de-escalation of P2Y12-inhibiting therapy. Indeed, individualized and alternative DAPT strategies may be chosen according to the clinical setting (stable coronary artery disease vs. acute coronary syndrome), the stage of the disease (early- vs. long-term treatment), and patient risk for ischemic and bleeding complications. A tailored DAPT approach may be potentially guided by platelet function testing (PFT) or genetic testing. Although the routine use of PFT or genetic testing in percutaneous coronary intervention-treated patients is not recommended, recent data have led to an update in guideline recommendations that allow considering selective use of PFT for DAPT de-escalation. However, guidelines do not expand on when to implement the selective use of such assays into decision making for personalized treatment approaches. Therefore, an international expert consensus group of key leaders from North America, Asia, and Europe with expertise in the field of antiplatelet treatment was convened. This document updates 2 prior consensus papers on this topic and summarizes the contemporary updated expert consensus recommendations for the selective use of PFT or genotyping in patients undergoing percutaneous coronary intervention.Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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